3 8.7 Inspection and Palpation of Ears

Inspect and palpate the ears. The patient should demonstrate behavioral cues indicating effective hearing.

Ear Inspection Assessment Method

1. External Ear

Method: Inspect the external ear, including the auricle (pinna) and tragus, for symmetry, size, shape, color position, and any signs of deformities or lesions.

Normal Findings:

• Ears are symmetric and proportionate to the head.
• The upper part of the auricle aligns horizontally with the outer canthus (corner) of the eyes.
• Skin is intact, with no lesions, lumps, or discoloration.

Abnormal Findings:

• Asymmetry or Deformity: May indicate congenital conditions like microtia or trauma.
• Low-Set Ears: Ears that are not aligned with the outer canthus of the eyes (low-set ears) may be associated with genetic disorders or congenital anomalies, such as Down syndrome or renal anomalies.
• Swelling, Redness, or Lesions: Could suggest infections (e.g., cellulitis), cysts, or skin conditions like eczema.
• Tenderness: Pain on palpation may suggest inflammation or infection, such as in otitis externa.

2. External Ear Canal Inspection (Using Penlight)

Method: Using a penlight, inspect the external ear canal by gently pulling the auricle up and back to straighten the canal. Look for any visible discharge, wax (cerumen), foreign bodies, or signs of inflammation.

Normal Findings:

• The external canal appears clear and free of obstructions.
• A light coating of cerumen is present, which is typically yellow to light brown in color.
• The canal’s skin is intact, with no visible redness or swelling.

Abnormal Findings:

• Critical Concern: Clear drainage from ear canal after trauma requires immediate assessment.
• Excessive Cerumen: Large amounts of earwax may be visible and could cause discomfort or hearing loss, requiring removal.
• Discharge: The presence of any discharge (yellow, green, or bloody) may indicate infection, such as otitis externa.
• Redness or Swelling: Visible inflammation in the canal could suggest infection or irritation, often associated with otitis externa.
• Foreign Bodies: Objects lodged in the canal, particularly common in children, need to be carefully noted and referred for removal.

Palpation of External Ear (Auricle and Tragus)

Method: Gently palpate the auricle, tragus, and mastoid process for tenderness, swelling, or any masses.

Normal Findings:

• The auricle and tragus are non-tender.
• No swelling, masses, or nodules are felt during palpation.

Abnormal Findings:

• Tenderness of the auricle or tragus: Pain upon palpation may suggest otitis externa, also known as swimmer’s ear.

Hearing Test

Nurses perform a basic hearing assessment during conversation with the patient. For example, the following patient cues during normal conversation can indicate hearing loss:

• Lip-reads or watches your face and lips closely rather than your eyes
• Leans forward or appears to strain to hear what you are saying
• Moves head in a position to catch sounds with the better ear
• Misunderstands your questions or frequently asks you to repeat
• Uses an inappropriately loud voice
• Demonstrates garbled speech or distorted vowel sounds^[1]

Whisper Test

The whispered voice test is an effective screening test used to detect hearing impairment if performed accurately. Complete the following steps to accurately perform this test^[2]:

• Stand at arm’s length behind the seated patient to prevent lipreading.
• Test each ear individually. The patient should be instructed to occlude the non-tested ear with their finger.
• Exhale before whispering and use as quiet a voice as possible.
• Whisper a combination of numbers and letters (for example, 4-K-2), and then ask the patient to repeat the sequence.
• If the patient responds correctly, their hearing is considered normal; if the patient responds incorrectly, the test is repeated using a different number/letter combination.
• The patient is considered to have passed the screening test if they repeat at least three out of a possible six numbers or letters correctly.
• The other ear is assessed similarly with a different combination of numbers and letters.