ANATOMY & PHYSIOLOGY • is a thick transparent sheet of

tissue providing a barrier between

Structure: the external ear and the middle
ear.
3 Divisions
STRUCTURES OF THE
1. external ear
EXTERNAL EAR
2. middle ear
Cerumen (wax) producing
3. inner ear
glands
EXTERNAL EAR
• protect and lubricate the ear canal,
Description
sebaceous glands and hair follicles.
• It is curved about 2.5 cm
Follicles and cerumen
long in adult and ends at the
tympanic membrane. protect the ear drum and

• The ear is attached to the head middle ear.

by skin and cartilage at about a 10
degree angle. STRUCTURES OF THE

• Adult- 1 to 1 1/2 inches (2.5- EXTERNAL EAR

3.75 cm)
landmark of auricle
EXTERNAL EAR
- lobule (earlobe)
Description
- helix (posterior curve of the
• It is covered with skin that has auricle’s upper aspect)
many fine hairs, glands and nerve
endings - antihelix (the anterior curve of the
auricle’s upper aspect
• It develops in embryo at the same
time as the kidneys and urinary STRUCTURES OF
tract.
THE EXTERNAL EAR
STRUCTURES OF THE
• external auditory
EXTERNAL EAR
canal
Auricle or Pinna
• mastoid process
• which is composed of cartilage
the bony bridge
covered by skin , it is embedded in
the temporal bone on both sides of located over the
the head at the level of the eyes.
temporal behind the
Tympanic membrane or
pinna.
“ear drum”
Mastoid bone • Contains the semi circular canals,
cochlea, vestibule, and the distal
- Part of the temporal lobe bone, found at end of the 8th cranial nerve
the back of the ear
·
Window membranes
STRUCTURES OF
Oval- where the sound vibration
enters THE INNER EAR

Round- sound vibration exits • Semicircular canals

MIDDLE EAR • These are tubes

made of cartilage
Description that contains air cells
and fluid
• begins at medial side of the ear
drum that starts at the tympanic • These canals are
membrane connected to sensory
fibers of the
• it consist of the EPITYMPANUM, an
vestibular portion of
air filled cavity (compartment)
the 8th cranial
containing 3 bony ossicles (bones
nerve.
of sounds transmission)
• contains the organs
3 ossicles of the
of equilibrium
middle ear
STRUCTURES OF
• malleus –“hammer”
THE INNER EAR Inner (Labyrinth)
– Most easily seen
Cochlea Organ of Corti
• incus – “anvil”
• is the spiral organ of hearing
• stapes - “stirrups”
• A sea shell shaped structure
• eustacian tube essential for sound transmission
and hearing
– Connects the middle ear to
the nasopharynx. • Bony Labyrinth- proctects the
membranous labyrinth
– The tube estabilizes the air
pressure between the • Semicircular Canals- resposible for
external atmosphere and balance
middle ear
Fluids
INNER EAR
• Perilymph- fluid at the bony
Description labyrinth

• Lies on the other side of the oval • Endolymph- fluid that fills
window the membranous labyrinth,
 - responsible for balance Personal history

Vestibule • ear trauma

Endolymph - a fluid similar to intracellular • ear surgery

fluid
• past infection

• excessive cerumen
EAR FUNCTION
• ear itch
• Hearing
• any invasive instrument routinely
used to clean the ear

• Sense of Balance • type and pattern of ear hygiene

AIR CONDUCTION PROCESS1. A sound • exposure to loud and noise music

stimulus enters the external canal
• air travel
and reaches the tympanic membrane.
Personal history
2. The sound waves vibrate the
tympanic membrane and reach the • swimming habits and protection
ossicles. when swimming

3. The sound waves travel from the
ossicles to the opening in inner ear
(oval window).
4. The cochlea receives the sound
vibrations
• history of hereditary factors and
health problems causing changes
of blood supply into the ear (heart
diease, HPN, and DM)
• vitiligo

5. The stimulus travels to the • smoking

auditory nerve (the eight cranial
nerve) and the cerebral cortex • vitamin B12 and folate deficiency

ASSESSMENT of the EAR • ototoxic drugs

PHYSICAL ASSESSMENT

• Ear and Hearing problems are • EXTERNAL EAR

common among adults of all ages.
Assessment of the ear and hearing • MASTOID ASSESSMENT
is important skill for nurses in any
• OTOSCOPIC ASSESSMENT
care environment.
• AUDITORY ASSESSMENT
• History
• VOICE TEST
• Demographic data
• WATCH TEST
• Family history and
genetic risk • AUDIOSCOPY
 • TUNING FORK (Weber test and
Rinne test)
• TYMPANOGRAM- measures middle
ear muscles reflex to sound
stimulation and compliance of
tympanic membrane
DIAGNOSTIC EXAMINATION
• CT
• MRI
• PHYSICAL ASSESSMENT OF THE
EAR WITH THE AID OF THESE
INSTRUMENTS
Speculum
Tuning fork
Direct inspection of the ear and inspection
of the remaining part by OTOSCOPE
(determination of the auditory acuity)
Palpation of the external ear
Usually assessed during initial physical
examination
Periodic reassessment may be necessary
for long – term clients or those with
hearing problems
WEBER’S TEST
(procedure)
- to assess bone conduction by testing the
lateralization (sideward transmission) of
sounds process
WEBER’S TEST
• hold the tuning fork at its base.
Activate it by tapping the fork
gently against the back of your
hand near the knuckles or by
stroking the fork between your
thumb and index fingers. It should
be made to ring softly
WEBER’S TEST
• place the base of the vibrating fork
on top of the client’s head and ask
the client hears the noise
• RINNE TEST
• this test compares air conduction
to
• bone conduction process.
RINNE TEST (procedure)
• ask the client to block the hearing
in one ear intermittently by moving
a fingertip in and out of the ear
canal
· hold the handle of the activated tuning
fork on the mastoid process of one ear
until the client states that the vibration
cannot longer be heard
RINNE TEST (procedure)
• immediately hold the still vibrating
fork prongs in front of the ear
canal. Ask whether the client now
hears the sound. Sound conducted
by air is heard more readily than
sound conducted by bone. The
tuning fork vibrations conduced by
air are normally heard longer.
VOICE TEST
• A simple hearing acuity test by
asking the client to block one
external ear canal while standing
1-2 feet away.
• Quietly whisper a statement and
then ask the client to repeat it.
Test each ear separately.
• AUDIOMETRYIs the
measurement of hearing
acuity.
Frequency
 • Highness/ lowness of tones
(expressed in hertz)
Intensity
• Expressed in decibels
Threshold
• Lowest level of intensity at which
pure tones and speech are heard
by a client (about 50% of the time)
Pure Tones
• Are generated by an audiometer to
determine hearing acuity.
SPEECH AUDIOMETRY
• to check the client’s ability to hear
spoken words is measured through
a microphone connected to an
audiometer.
• ELECTRONYSTAGMOGRAPHY
(ENG) A cost effective test that
is sensitive in detecting both
central and peripheral disease
of the vestibular system in the
ear.
• Detects nystagmus that can be
recorded.
• ELECTRONYSTAGMOGRAPHY
(ENG) Electrodes are taped to
the skin near the eyes
• One or more procedures
(caloric testing, changing gaze
position or changing head
position ) are performed to
stimulate nystagmus.
• DIX HALLPIKE TESTA test for
vertigo performed by assisting the
client to a sitting position on an
examination table
• DIX HALLPIKE TEST
(W/ MAT TABLE) Stand to the side
of the client and quickly reposition
her from sitting to supine with the
head extending beyond the end of
the table.
• This change of position is done first
to one side and then to the other
side.
• A client with benign positional
vertigo will have a burst of
nystagmus after a delay of 5-10
seconds.
• CALORIC TESTINGEvaluates the
vestibular (inner-ear) portion
of the auditory nerve.
• Water warmer or cooler than
body temperature is infused
into the ear.
• A normal response is the onset
of vertigo (spinning sensation)
and nystagmus within 20-30
seconds.
• BONE CONDUCTION TESTPure-
tone bone-conduction testing
determines whether the
hearing loss detected by an air-
conduction testing is due to
conductive or sensorineural
factors or to a combination of
two.
• g. Romberg’s Test- test for balance
• TYMPANOPLASTYReconstructs
the middle ear to improve
hearing caused by conductive
hearing loss.
• Varies from simple
reconstruction of the eardrum
(myringoplasty) to replacement
of the ossicles within the
eardrum.