Physical Examination Ears 36 EARS Inspects externally bilaterally

Physical Examination Ears 36 EARS: Inspects externally bilaterally (including behind ears) 37 Palpates auricles bilaterally 38 Otoscopic examination bilaterally 39 Otoscopic examination performed without pain 40 Auricles pulled superiorly, posteriorly, and away from patient 41 42 Auditory acuity tested (eyes closed if finger rub and you can see movement of hands or arm) Auditory acuity tested correctly (each ear independently, etc. )

36. The ears need to be closely inspected, including behind the ears. 37. Palpate the ears between two fingers for any masses or tenderness. Now is a good time to ask the patient if he/she has noticed any change in their hearing.

Auditory acuity needs to be tested in both ears independently. • Having the patient cover their other ear and lightly rubbing your fingers from 3 feet and ask the patient to tell you when they hear it, and move your fingers closer to the patient can approximate auditory acuity. • The patient's eyes need to be closed if you use the finger rub to test acuity, since they may see your arm or clothing move. You could also cover your mouth and whisper numbers or letters from three (3) feet and move closer to the patient and have the patient repeat what you are saying. • The person with normal hearing will be able to hear your fingers anywhere from when you start to

Otoscope Holding the Otoscope

Otoscopic examination needs to be done bilaterally. • You should always be visualizing the opening to the ear canal before and • while advancing the speculum. (This will avoid causing undue pain. ) • In adults, the auricle is pulled posteriorly, superiorly and away from the patient to straig • This will help facilitate visualization of tympanic membrane.

Anatomy of the tympanic membrane (note the line of myringotomy is not an anatomical structure, it is where the surgeon makes the incision to place a tube in the ear)