Physical%20Examination

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Physical Examination

• Ears

• EARS Inspects externally bilaterally
  (including behind ears)
• Palpates auricles bilaterally
• Otoscopic examination bilaterally
• Otoscopic examination performed without pain
• Auricles pulled superiorly, posteriorly, and
  away from patient
• 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.)

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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.
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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
  about 2 feet.

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Otoscope
Holding the Otoscope
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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
  straighten out the canal.
• This will help facilitate visualization of
  tympanic membrane.

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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)