The nurse is assessing a patient for a possible conductive hearing loss. What should the nurse perform first?
1. external ear exam
2. Weber test
3. Rinne test
4. tympanogram
Correct Answer: 1
Visual inspection of the external ear will give information about possible obstruction by cerumen, drainage, redness, swelling, or objects present in the external canal. Visual inspection can also show the condition of the tympanic membrane (intact or ruptured), swelling, redness, and scarring. Pain also might be identified when using the otoscope to visualize the structures in the external canal. A Weber test is done to identify the equality of sound heard in both ears. This would be the next step in the assessment process. Normally, sound is heard equally in both ears. A Rinne test is done to identify the difference between bone and air conduction of sound by each ear. This is the third step. Normally, sound can be heard twice as long by air conduction as by bone conduction. Tympanograms are done to measure the pressure of the middle ear by evaluating the tympanic membrane's response to waves of pressure. This test would be done last, only if other symptoms were noted or indicated by the nurse's findings.
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