Assessing the Ears Visual Inspection of the Ear Essay Assignment Paper

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Assessing the Ears Visual Inspection of the Ear Essay Assignment Paper

Policies and Perspectives

Complete the Health Policy and Perspectives grid based on the scenario that your instructor has provided to you.

Identify 4 to 5 stakeholders whose perspectives must be considered in the policy.

Complete all sections of the grid with a statement on the varying perspectives of the various stakeholders that you have identified and who are involved in the policy issue.

List 4-5 Stakeholders who would be affected by this policy: Possible perspectives held by these stakeholders:
Conservative Liberal Legal Religious Ethical Cultural Societal Economic
Be sure to properly cite any references used in APA format.

Copyright © 2014 by University of Phoenix. All rights reserved.

Assessing the Ears Visual Inspection of the Ear

Check both ears for symmetry. Inspect the external ear and look for the following:

If the upper level of the ear rests below the level of the pupils, consider a congenital abnormality such as Down’s syndrome. Note: Congenital abnormalities of the ear, in general, may be associated with abnormalities of the kidneys, heart, and great vessels. (Kidney lesions tend to be ipsilateral to the ear abnormality).

Check for basal or squamous cells, solar keratoses, or other potentially harmful skin lesions. For example, a crusted ulcer on the pinna suggests squamous cell carcinoma.

A unilateral painful rash with vesicles on the lower ear suggests herpes zoster of the geniculate ganglion (Ramsay Hunt syndrome). Be sure to check for this in any patient who presents with facial paralysis.[1]

A unilateral bright red swollen ear suggests external otitis.

Red, lax, or floppy ears suggest relapsing polychondritis. It typically occurs with a sudden onset of unilateral or bilateral ear pain, swelling, and redness, sparing the lobules.[2]

In superficial skin infections, such as erysipelas, the ears can be involved, but subcutaneous infections, like cellulitis, spare the ear (Millian’s sign).

Long ear hairs suggest normal androgenic function (Hamilton’s sign).

Abnormalities to the ear caused by trauma often present as a thick, rubbery painless deformity.

A diagonal ear lobe crease suggests increased risk for coronary artery disease.

Examining the Ears, Nose, and Oral Cavity in the Older Patient Mark E. Williams, MD
3/19/2016 2/15

Tender chalky nodules on the pinna suggest gouty tophi in a person who has lived in a cold climate, as lower temperature reduces the solubility of uric acid.

Single nontender nodule on the helix present since birth suggests a Darwinian tubercle (auricular tubercle).

Movement of the ear lobe coincident with the pulse suggests tricuspid insufficiency (Paul Dudley White’s winking ear lobe sign).[3]

Palpation of the Ear

Stiffness of the earlobe suggests Addison’s disease, while stiffness of the pinna and auricular cartilage suggests other endocrine abnormalities, such as hyperthyroidism, acromegaly, diabetes mellitus, and hypopituitarism. Consider external otitis media if the patient’s ear is painful when you tug on it or if you find a tender tragus. Note: This is a potentially serious problem in diabetic or immunocompromised patients because of a risk for progression to osteomyelitis involving the temporal bone (called malignant external otitis). In such patients, check for mastoiditis by palpating the suprameatal triangle of MacEwen, which is the depression at 11 o’clock on the right ear and 1 o’clock on the left ear. (You can locate these little depressions on your own ears.) This area is tender when mastoiditis is present but is not with external otitis media alone.

Screening for Hearing Loss

Hearing loss is the third most common chronic health condition among older Americans after high blood pressure and arthritis; an estimated 25% to 40% of adults over age 65 and 40% to 66% of people 75 years and older have at least some hearing loss.[4] Some evidence suggests that hearing loss may be an indicator of cognitive decline.[5] However, in some older patients thought to be demented or psychiatric, hearing loss may actually be the basis for their odd behavior. If the patient appears to have hearing loss, then the next step would be to refer the patient for audiology testing, typically with a trained audiologist.

Simple Test to Determine Presence of Hearing Loss. One useful initial way to determine whether a patient has hearing loss is to give a simple instruction without providing a visual clue. For example, stand behind the patient during a lung or back examination, and give a simple command, such as “ra

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