Question

You are conducting a head-to-toe assessment on your patient, how would you know that your patient has a hearing problem and what will be your intervention to address this problem. provide references

Answer 1

Ans) Hearing Assessment:

-1st inspect & palpate the external ear:

• -size & shape
• -skin condition (frostbite)
• -tenderness
• -auditory meatus (cerumen)
• -normal findings: hair & cerumen
• -abnormal findings: erythema or discoloration, otorrhea (ear discharge), blood, foreign body

2) Next perform an otoscope examination

-largest speculum
-patient's head tilted away
-adult & older child: pull pinna up & back
-infant & child under 3: pull pinna down

3) Test hearing acuity:

- Whisper test: determine ability to hear whispered 2 syllable words from 2 feet away
- Weber test: a vibrating tuning fork in contact w/ the top of the head should be heard equally well in both ears
- Rinne test: compares bone conduction to air conduction. AC>BC


4) To assess the vestibular apparatus, perform the Romberg test:

- A patient who has a problem with proprioception can still maintain balance by using vestibular function and vision. In the Romberg test, the standing patient is asked to close his or her eyes. An increased loss of balance is interpreted as a positive Romberg's test.

5) Adjust assessment technique or expected findings based on patient's developmental stage

Objective data:- Inspection: behavioral responses to speech to identify cue that might indicate hearing loss; ear position, size, shape and condition of skin on external ear as well as facial tone; TM to note color characteristics (no shine could mean infection), position integrity (done mainly by advanced practice)
- Palpate: external ear to note lumps, masses, tenderness on auricle
- Whister Test: evaluate for high pitched hearing loss
- Otoscopic Eval: inspect external canal for cerumen discharge, foreign bodies, erythema or lesions