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Purpose
Hearing loss is a common condition, affecting about 9 million people in England. It usually happens gradually as people get older and is most common in people over 65. Hearing difficulties can happen at any age and have several causes. People often put off getting help for hearing loss, yet it can have a major impact on their quality of life, causing them to lose confidence and feel isolated from family and friends. It can also lead to depression and anxiety (National Institute for Health and Care Excellence (NICE), 2018).
Consequently, monitoring and maintenance of hearing are fundamental parts of nursing assessment (Dougherty et al, 2015). Apart from hearing, ears are crucial for balance, and poor hygiene can contribute to poor hearing and cerumen impaction (also known as earwax impaction) (Millward, 2017).
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Assessment
Anatomy and physiology
It is important that health professionals understand the anatomy and physiology of the ear to enable them to assess and diagnose ear conditions. The ear has three main parts (Figure 1):
The outer/external ear consists of the pinna (auricle) and external auditory meatus (EAM)—the acoustic canal lined with small hairs. The epithelium covers the tympanic membrane and contains the cerumen glands (Bickley et al, 2012). The main function of cerumen is to lubricate the ear, but it also protects the canal (Berman and Snyder, 2012). The pinna collects sound waves, which reach the auricle, and delivers them via the external acoustic canal to the tympanic membrane, which vibrates (Dougherty et al, 2015)
The middle ear is an air-filled cavity that starts at the tympanic membrane. It contains three ossicles or bones of sound transmission—the malleolus, incus and stapes, collectively known as the auditory ossicles—which also receive vibrations
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Risks and complications
Abnormalities
Cerumen excess
Cerumen build-up, which is common, can prevent adequate clinical examination of the ear and sometimes delay investigations and management. Each year, an estimated 2.3 million people have issues with cerumen that are sufficient to need intervention (NICE, 2018). Some of the most common causes of build-up and ear damage is due to the use of hearing aids or earbud-type headphones, and the use of cotton buds (Castella, 2018). Other reasons for build-up or impaction include working in very dusty or dirty environments, patients having excessive hair in or around their ears, or having ears with narrow ear canals (O'Brien, 2012).
Symptoms of cerumen build-up include tinnitus, vertigo, discharge, pain, hearing loss, and otitis externa. Treatment of cerumen impaction includes using pre-treatment wax softeners either immediately before or up to 5 days before ear irrigation or syringing is carried out by an appropriately qualified health professional (Castella, 2018).
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Procedure
| Whispered voice test | Procedure
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| Weber test (tests for lateralisation) | Procedure
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Resources
References
Baillie L (ed). Developing practical nursing skills. (4th edn). Boca Raton (FL): CRC Press; 2014.
British Society of Audiology. Recommended procedure. Rinne and Weber tuning fork tests. 2016. https://www.thebsa.org.uk/wp-content/uploads/1987/04/Recommended-Procedure-Tuning-Forks-2016.pdf (accessed 6 December 2022)
British Tinnitus Association. Tinnitus services. 2017. https://www.tinnitus.org.uk/tinnitus-services (accessed 6 December 2019)
Brooker C, Nicol M, Alexander MF (eds). Alexander's nursing practice. (4th edn). Edinburgh: Churchill Livingstone Elsevier; 2015
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