auditory system assessment, an evaluation of the patient’s ears and hearing and an investigation of present and past diseases or conditions that may be responsible for an auditory impairment. ▪ METHOD: The client is questioned in verbal or written form regarding previous ear problems, especially childhood problems of otitis media, perforations of the eardrum, and drainage, and history of measles, mumps, or scarlet fever. Information is obtained about past or present ototoxic medications, such as aspirin, chemotherapeutic drugs, NSAIDs. streptomycin, aminoglycerides, or diuretics. Previous ear surgeries as well as tonsillectomy and adenoidectomy or head injury are also documented. Use of a hearing aid and problems with compacted cerumin are noted. Symptoms of dizziness, ringing in the ears, and hearing loss are recorded. Information regarding allergies, prematurity, and family members with hearing loss is documented. Chronic medical conditions such as diabetes or cancer as well as occupational exposures to high-noise environments, with or without protection, are also important. Recreational ear hazards, such as swimming or chronic exposure to loud music, are noted. Physical examination includes inspection and palpation of the external ear including the mastoid area for tenderness, swelling, redness, nodules, or lesions. Otoscopic examination is then performed to assess the ear canal and tympanic membrance. Diagnostic procedures indicated by the history may include audiometry, a mastoid x-ray film, Rinne and Weber tuning-fork tests, and microbiological studies for potential pathogens in smears of ear drainage. ▪ PATIENT CARE CONSIDERATIONS: The health care provider conducts the interview, makes the observations, and collects the pertinent background information and the results of the diagnostic procedures. ▪ OUTCOME CRITERIA: A thorough assessment of the patient’s auditory system is essential in establishing the diagnosis of an ear disorder.
