EARS-AND-HEARING.pptxarh rth3445y43qcg54gt

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1. Ears and Hearing

2. Assessment of the ear includes direct inspection of the external parts of the ear inspection of the internal part of the ear by an otoscope determination of auditory acuity

3. The Human Ear

4. The external ear canal is curved, about 2.5 cm (1 in) long in adult, and ends at the tympanic membrane. It is curved with skin that many fine hairs, glands, and nerve endings. The glands secrete cerumen (earwax), which lubricates and protects the canal

5. The curvature of the external ear canal differs with age in infant and toddler, the canal has an upwardcurvature by age 3, the ear canal assumes the more downward curvature of adulthood

6. Eustachian Tube Connects the middle ear to the nasopharynx The tube stabilizes the air pressure between the external atmosphere and the middle ear prevent rupture of the tympanic membrane and discomfort produced by marked pressure differences

7. The inner ear contains: cochlea (a shell-shaped structure essential for sound transmission and hearing vestibule and semi circular canal (contain organs of equilibrium)

8. Sound transmission and hearing are complex process. Sound conduction can be transmitted by air conduction or bone conduction

9. Sound transmission

10. Bone-conducted sound transmission occurs when skull bones transport directly to the auditory nerve.

11. Audiometric evaluations (measure hearing at various decibels) are recommended for children and older adults. A common hearing deficit with age is loss of ability to hear high-frequency sounds such as: f s sh ph

12. Conductive Hearing Loss The result of interrupted transmission of sound waves through the outer and middle ear structures. Possible cause: tear in the tympanic membrane obstruction in the auditory canal

13. Sensorineural Hearing Loss The result of damage to the inner ear, the auditory nerve, or the hearing center in the brain.

14. Mixed Hearing Loss A combination of conduction and sensorineural loss

15. Assessing the Auricles Inspect auricles for color, symmetry of size, and position. Normal Findings: color same as facial skin

16. Deviations: bluish color (cyanosis) pallor (frostbite) excessive redness (inflammation or fever)

17. To inspect position, note the level at which the superior aspect of the auricle attaches to the head in relation to the eye. Normal Findings: symmetrical auricle aligned with outer canthus of the eye, about 10º, from vertical

18. Deviations: asymmetry low-set ears (Down syndrome)

19. Palpate the auricles for texture, elasticity, and areas of tenderness. gently pull the auricle upward, downward, and backward fold the pinna forward (it should recoil) push in on the tragus apply pressure to the mastoid process

20. Normal Findings: mobile, firm, and non-tender pinna recoils after it is folded Deviations: lesions flaky, scaly skin tenderness when moved or pressed (indicate inflammation or infection of external ear

21. External Ear Canal and Tympanic Membrane Inspect the external ear canal for cerumen, skin lesions, pus, and blood. Normal Findings: distal third contains hair follicles and glands dry cerumen, grayish-tan color sticky wet cerumen

22. Deviations: redness and discharge scaling excessive cerumen obstructing canal

23. Visualize the tympanic membrane using an otoscope. Tip the client's head away from you, and straighten ear canal. adult: straighten the ear canal by pulling the pinna up and back to facilitate vision

24. Inspect the tympanic membrane for color and gloss. Normal Findings: pearly gray color, semitransparent Deviations: pink to red, some opacity yellow-amber blue or deep red dull surface

25. Gross Hearing Acuity Tests Assess client's responses to normal voice tones. if client has difficulty hearing normal voice, proceed with the following tests. Normal Findings: normal voice tone audible

26. Deviations: normal tone voice not audible requests nurse to repeat words or statements leans torward speaker turns the head cups the ears speaks in a loud tone of voice

27. Perform the whisper test to assess high-frequency hearing. have the client occlude one ear out of the client's sight, at a distance of 1 to 2 feet, whisper a simple phrase ask the client to repeat the phrase repeat with the other ear using a different phrase

28. Normal Findings: Able to repeat the phrases correctly in both ears. Deviations: Unable to repeat the phrases in one or both ears.

29. Perform Weber's test to assess bone by examining the lateralization (sideward transmission) of sounds. hold the tuning at its base activate it by tapping the fork gently gainst the back of your hand near the knuckles or by stroking the fork between your thumb and index finger it should be made to ring softly

30. Place the base of the vibrating fork on top of the client's head and ask where the client hears the noise. Normal Findings: sound is heard in both ears or is localized at the center of the head (Weber negative)

31. Deviations: sound is heard better in impaired ear indicating a bone-conductive hearing loss sound is heard better in ear without a problem indicating a sensorineural disturbance (Weber positive)

32. Conduct the Rinne test to compare air conduction to bone conduction. hold the handle of the activated tuning fork on the mastoid process of the ear until the client states that the vibration can no longer be heard

33. Immediately hold the still vibrating fork prongs in front of the client's ear canal. ask whether the client now hears the sound sound conducted by air is heard more readily than sound conducted by bone

34. Normal Findings: Air-conducted (AC) hearing is greater than bone-conducted hearing AC > BC (positive Rinne) Deviations: bone conduction time is equal to or longer than the air conduction time (BC>AC or BC=AC) negative Rinne indicates a conductive hearing loss

35. LIFESPAN CONSIDERATIONS Infants To assess gross hearing, ring a bell from behind the infant or have the parent call the child's name to check for a response. Newborn will quiet to the sound and may open their eyes wider. By 3 to 4 months of age, the child will turn head and eyes toward the sound. All newborns should be assessed for hearing prior to discharge from hospital.

36. Children To inspect external canal and tympanic membrane in children less than 3 years old: pull the pinna down and back Perform routine hearing checks and follow up on abnormal results. Noise-induced hearing loss is becoming more common in adolescents and young adults as a result of exposure to loud music and prolonged use of headsets at extremely loud volumes.

37. Older Adults The skin of the ear may appear dry and be less resilient because of the loss of connective tissue. Increased coarse and wirelike hair growth occurs along the helix, antihelix, and tragus. The pinna increases in both width and length, and the earlobe elongates.

38. Earwax is drier. The tympanic membrane is more translucent and less flexible. Sensorineural hearing loss occurs. Generalized hearing loss (presbycusis) occurs in all frequencies, although the first symptom is the loss of high frequency sounds. To such individuals, conversation can be distorted and result in what appears to be inappropriate or confused behavior.