Assessment Technique
Inspect: pinna (position, deformity), ear canal (discharge, swelling, foreign body), tympanic membrane (color, landmarks, light reflex, perforation). Palpate: mastoid process, lymph nodes. Hearing: whisper test, tuning fork tests (Weber, Rinne). Audiometry for comprehensive evaluation.
Types of Hearing Loss
Conductive: outer/middle ear problem (wax, infection, otosclerosis, perforation). Weber: lateralizes to affected ear. Rinne: bone > air. Sensorineural: inner ear/auditory nerve damage (aging, noise, ototoxic drugs, Meniere). Weber: lateralizes to unaffected ear. Rinne: air > bone (both reduced). Presbycusis: age-related sensorineural.
Nursing Care
Communicate effectively: face patient, speak slowly, reduce background noise, use written communication. Hearing aids: clean, check batteries. Cochlear implants for severe sensorineural. Ototoxic medications: monitor (aminoglycosides, loop diuretics, chemo). Prevent noise-induced loss: hearing protection. Report: sudden hearing loss, ear pain, discharge, vertigo, tinnitus.
Important Notes
- Sudden sensorineural hearing loss is an emergency — treatment with steroids within 72 hours improves outcomes.
- Ototoxic medications (aminoglycosides, furosemide, cisplatin) require baseline and ongoing hearing monitoring.
Clinical Tips
- Weber test: conductive loss lateralizes to affected ear, sensorineural to unaffected ear.
- Presbycusis (age-related) typically affects high frequencies first — patients have trouble hearing consonants.
Summary
Ear assessment includes otoscopy, tuning fork tests, and audiometry. Hearing loss types (conductive, sensorineural) guide treatment and communication strategies.
