Physical assessment - Ears: Nursing

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PHYSICAL ASSESSMENT - EARS
	KEY POINTS	NOTES
DEFINITION	Completed apart of Comprehensive assessment Focused assessment
GETTING STARTED	Supplies Otoscope Penlight Gloves Light source Preparation Ensure patient is comfortable Warm hands Adjust room temperature Provide privacy Explain procedure Answer any questions Obtain verbal consent Perform hand hygiene Gather supplies
ANATOMICAL LANDMARKS	External ear Auricle also called pinna Tragus Lobule or earlobe External auditory canal Mastoid process Middle ear Ossicles Tympanic membrane Inner ear
METHODS OF ASSESSMENT	Inspection Palpation Special tests Whisper test Romberg test
INSPECTION	External ear View auricles on both sides Check size shape and symmetry Skin should match face color Inspect ear position Top of auricle aligns with eye Low set ears may indicate abnormality Ears should have no lesions or nodules Darwin tubercle is a normal thickening Cauliflower ear from repeated ear trauma Tophi are white uric acid deposits Look for sebaceous cysts External auditory canal Canal should have no drainage or odor Use penlight to view canal Foul smell may indicate infection Bloody drainage may suggest trauma Otoscope Hold otoscope and pull auricle upward Insert otoscope about 1.5 cm Look for lesions cerumen or foreign bodies Normal tissue has fine hairs Tympanic membrane should be flat and gray Perforated membrane may result from trauma Red bulging membrane suggests otitis media Retracted membrane may indicate tube obstruction
PALPATION	Auricles and mastoid process Check for tenderness edema or nodules Auricle should feel firm and flexible Push tragus and pull lobule downward Tenderness may suggest inflammation present Mastoid tenderness may indicate mastoiditis
SPECIAL TESTS	Whisper test Assess cranial nerve VIII Occlude one ear with finger Whisper word behind unoccluded ear Patient should repeat whispered word Inability may suggest high frequency loss May also indicate auditory canal blockage Romberg test Assess balance and equilibrium Patient stands with feet together Eyes open arms at sides Patient should remain balanced and steady Ask patient to close eyes Observe for about thirty seconds Stay close to prevent falling Mild swaying is considered normal Excessive swaying or falling is abnormal
NURSING IMPLICATIONS	Assess Interpret Document Report abnormal or emergent findings to HCP Monitor patient progress and baseline changes

Assessment of the ears should be completed as part of a comprehensive client assessment, or as part of a focused exam if the client is experiencing issues such as ear pain or hearing loss. This assessment gives the nurse information about hearing and equilibrium while helping to identify ear problems, such as otitis media. Let’s review the process of completing an ear assessment.

Okay, the supplies you’ll need for the ear assessment include an otoscope, a penlight, gloves, and a good source of light. Then, prepare for the exam by ensuring your client is in a comfortable position, that your hands are warm, and that the temperature in the room is comfortable. Also remember to provide privacy by closing the door and curtains.

Before getting started, explain the procedure to your client and be sure to answer any questions they might have before obtaining verbal consent. Then, perform hand hygiene and collect your supplies.

Now, locating the anatomical landmarks of the ears and surrounding tissue will help guide your assessment. The ear is divided into three sections: the external ear, middle ear, and the inner ear. Starting with the external ear, the landmarks include the auricle, also known as the pinna; the tragus; the lobule, or earlobe; the external auditory canal; and the mastoid process, which is the area directly behind the ear. Next, the middle ear contains the ossicles and the tympanic membrane which work together to transmit sound to the inner ear.

Alright, the methods of ear assessment include inspection and palpation as well as special tests, including the whisper test and the Romberg test.

First, you should inspect the external ear by viewing the auricles bilaterally, looking for size, shape, and symmetry. Also check that the skin on the auricles are the same color as their face. Be sure to inspect the position of the ears. Normally, the top of the auricle should align with the inner canthus of the eye. Clients with low-set ears may have a congenital abnormality. The ears should be free of lesions or nodules; however, a thickening of the upper helix of the auricle, called a Darwin tubercle, is an expected finding in some clients. Other ear abnormalities include cauliflower ear, tophi, or a sebaceous cyst. Cauliflower ear appears as an enlarged and thickened auricle and occurs from repeated trauma to the ear. Tophi are small white deposits of uric acid that appear along the auricles and are associated with gout. Sebaceous cysts indicate that the client has a blockage in their sebaceous glands, and appear as elevations in the skin around the ear.

Now, let’s move on to the external auditory canal, which should be free from drainage, odor, or excessive cerumen. You may need a penlight to view the canal, especially if your client has a buildup of cerumen. A foul smell or purulent drainage can be signs of otitis externa or may indicate the presence of a foreign body; whereas bloody drainage can be associated with trauma.

Physical assessment - Ears: Nursing

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