PROCEDURE CHECKLIST
Chapter 19: Assessing the Ears and Hearing
Check (9) Yes or No
PROCEDURE STEPS Yes No COMMENTS
1. Inspect the external ear for placement, size, shape,
symmetry, drainage, lesions, and color and condition of
skin.
2. Palpate the external structures of the ear for condition of
skin and tenderness.
3. Using otoscope, inspects tympanic membrane and bony
landmarks.
a. Uses correct size speculum.
b. Has patient tilt head to side not being examined.
c. Looks for foreign object in canal before inserting
scope.
d. For Adult: Pulls helix up and back.
For Preschool Child: Pulls helix down and back.
e. Inserts speculum slowly, only into outer 1/3 of canal.
f. Identifies location of cone of light and bony
landmarks.
g. Uses “puff” of air to test TM mobility.
4. Tests gross hearing.
a. Stands 1 to 2 feet behind the patient. Has the patient
cover one ear as you whisper some words. Repeats on
the other side. Has the patient repeat the words heard.
b. Has the patient occlude one ear. Holds a ticking
watch next to the patient’s unobstructed ear. Slowly
moves it away until the patient says he can hear the
sound.
5. Performs Weber test (places vibrating tuning fork on top
of patient’s head, identifying as positive if sound not heard
equally in both ears).
6. Performs Rinne test if Weber is positive.
a. Strikes a tuning fork on the table. While it is still
vibrating, places it on the patient’s mastoid process.
b. Measures the time in seconds that the patient hears
the vibration.
c. Moves the tuning fork to 1 inch (2.5 cm) in front of
the ear and measure the time until the patient can no
longer hear the vibration.
d. Compares AC and BC times.
7. Performs Romberg test: Has client stand with feet
together, hands at side with eyes opened and then with eyes
Copyright © 2007, F. A. Davis Company, Wilkinson & Van Leuven/Procedure Checklists for Fundamentals of Nursing
closed. Notes ability to maintain balance. Identifies
swaying as positive Romberg.
8. Compares bilaterally throughout examination.
Recommendation: Pass _____ Needs more practice _____
Student: Date:
Instructor: Date:
Copyright © 2007, F. A. Davis Company, Wilkinson & Van Leuven/Procedure Checklists for Fundamentals of Nursing
