NCLEX Review Guide: Ear Diagnostic Tests

Otoscopic Examination

• The otoscope allows direct visualization of the external auditory canal and tympanic membrane. Insert the speculum only 1-1.5 cm into the adult ear canal to prevent injury.
• Normal tympanic membrane appears pearly gray, translucent, and moves freely with insufflation. Abnormal findings include redness, bulging, perforation, or lack of mobility.
• Pull the adult ear up and back (posterior-superior) to straighten the S-shaped canal, while children's ears are pulled down and back.

Weber and Rinne Tests

• Weber test uses a tuning fork placed on the center of the forehead to assess bone conduction. Sound should be heard equally in both ears in normal hearing.
• Rinne test compares air conduction to bone conduction by placing the tuning fork on the mastoid process, then near the ear canal. Air conduction should be twice as long as bone conduction.
• In conductive hearing loss, Weber lateralizes to the affected ear, and bone conduction equals or exceeds air conduction in Rinne test.
• In sensorineural hearing loss, Weber lateralizes to the unaffected ear, and air conduction remains longer than bone conduction.

Audiometry and Tympanometry

• Pure tone audiometry measures hearing thresholds at different frequencies using headphones and bone conduction vibrators. Results are plotted on an audiogram showing hearing levels in decibels.
• Tympanometry measures eardrum mobility and middle ear pressure by creating pressure changes in the ear canal. Normal tympanogram shows a peaked curve at atmospheric pressure.
• Contraindications for tympanometry include acute otitis media, perforated tympanic membrane, or excessive cerumen impaction.

Balance and Vestibular Function

• Romberg test assesses balance by having the patient stand with feet together, arms at sides, first with eyes open, then closed. Positive test shows increased swaying with eyes closed.
• Electronystagmography (ENG) records eye movements to evaluate vestibular function and diagnose causes of dizziness or vertigo.
• Caloric testing involves irrigating the ear canal with warm or cool water to stimulate the vestibular system and observe nystagmus response.

Romberg Test Procedure

1. Position patient standing with feet together
2. Have patient extend arms forward with eyes open
3. Observe for 30 seconds, then have patient close eyes
4. Continue observation for 30 seconds
5. Note any increased swaying or loss of balance