{"id":2967,"date":"2024-08-13T09:41:43","date_gmt":"2024-08-13T13:41:43","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/?post_type=chapter&#038;p=2967"},"modified":"2025-01-03T15:00:10","modified_gmt":"2025-01-03T20:00:10","slug":"inspection-and-palpation-of-external-ear","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/inspection-and-palpation-of-external-ear\/","title":{"raw":"Inspection and Palpation of External Ear","rendered":"Inspection and Palpation of External Ear"},"content":{"raw":"<p style=\"text-align: left\"><span style=\"color: #000000\">Inspection and palpation of the external ear can be done with the client in any position, but is typically completed with the client sitting in an upright position.\u00a0<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Steps of <strong>inspection<\/strong> include (see <strong>Video 1<\/strong>):<\/span><\/p>\r\n\r\n<ol>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Inspect <strong>symmetry<\/strong>, <strong>lesions<\/strong>, and <strong>deformities<\/strong> on or around the ears.<\/span>\r\n<ul>\r\n \t<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\">Normally, the ears are symmetrical with no lesions or deformities. However, one common and normal ear lesion is Darwin's tubercle (a thickening of or nodule on the middle to upper portion of the helix) (<strong>Figure 3<\/strong>).\u00a0<\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">In some congenital abnormalities, one ear is significantly smaller or larger, or parts of an ear or the whole ear is not present. Another common deformity is cauliflower ear (<strong>Figure 4<\/strong>) caused by a physical trauma to the ear such as a sports injury: disruption to the blood supply causes inflammation and cartilage overgrowth, resulting in a deformity that has the textured appearance of a cauliflower. Ear keloids (<strong>Figure 5<\/strong> and <strong>6<\/strong>) are also a common deformity: these are nodules that can range in size and are firm and rubbery, often caused by minor trauma and scar tissue formation such as with ear-piercing. Ear keloids usually have the same colour as the client\u2019s skin, but can also appear as shades of pink, red, and purple.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ol>\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/12\/Darwins-tubercle-207x300.png\" alt=\"Shows a small nodule on the ear's helix\" width=\"207\" height=\"300\" class=\"size-medium wp-image-3616 aligncenter\" \/>\r\n\r\n<span style=\"color: #000000\"><strong>Figure 3<\/strong>: Darwin's tubercle.<\/span>\r\n\r\n&nbsp;\r\n\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-3-Cauliflower-ear.png\" alt=\"\" width=\"215\" height=\"288\" class=\"wp-image-3050 aligncenter\" \/>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 4<\/strong>: Cauliflower ear.\u00a0(From:<\/span> <a href=\"https:\/\/jetem.org\/cauliflower_ear\/cauliflower-ear-photograph-1-jetem-2018\/\" target=\"_blank\" rel=\"noopener\">https:\/\/jetem.org\/cauliflower_ear\/cauliflower-ear-photograph-1-jetem-2018\/<\/a> <span style=\"color: #000000\">Cauliflower Ear. Photograph 1. JETem 2018 6. This work is licensed under a <\/span><a href=\"http:\/\/creativecommons.org\/licenses\/by\/4.0\/\" target=\"_blank\" rel=\"noopener\">Creative Commons Attribution 4.0 International License<\/a><span style=\"color: #000000\">).<\/span><\/p>\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-4-Ear-keloid.png\" alt=\"\" width=\"297\" height=\"198\" class=\"wp-image-3051 aligncenter\" \/>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 5<\/strong>: Ear keloid. (By Htirgan, This file is licensed under the <\/span><a href=\"https:\/\/en.wikipedia.org\/wiki\/en:Creative_Commons\" target=\"_blank\" rel=\"noopener\">Creative Commons<\/a> <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/3.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Attribution-Share Alike 3.0 Unported<\/a> <span style=\"color: #000000\">license,<\/span> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Earlobe_Keloid,_Bulky.JPG\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.org\/wiki\/File:Earlobe_Keloid,_Bulky.JPG<\/a><span style=\"color: #000000\">)<\/span><\/p>\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-5-Ear-keloid-300x200.png\" alt=\"\" width=\"300\" height=\"200\" class=\"size-medium wp-image-3052 aligncenter\" \/>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 6<\/strong>: Ear keloid (right image). By Htirgan - Own work,<\/span> <a href=\"https:\/\/en.wikipedia.org\/wiki\/en:Creative_Commons\" target=\"_blank\" rel=\"noopener\">Creative Commons<\/a> <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/3.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Attribution-Share Alike 3.0 Unported<\/a><span style=\"color: #000000\"> license,<\/span> <a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=32782666\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=32782666<\/a><\/p>\r\n\r\n<ol start=\"2\">\r\n \t<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\">Inspect for<strong> skin integrity<\/strong>, <strong>colour<\/strong>, and <strong>swelling<\/strong> on and around the ears.<\/span>\r\n<ul>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Normally, the skin is intact with no signs of discolouration or swelling. If piercings are present, assess for and describe any signs of infection such as erythema and swelling.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Abnormal findings may include skin that is not intact such as an open ulcer (<strong>Figure 7<\/strong>) or the presence of scars. Discolouration of the ear from the client\u2019s baseline is important to evaluate such as erythema (<strong>Figure 8<\/strong>) and swollen or darker than the client\u2019s baseline skin colour including shades of purple and blue and turning very black. If present, describe the location and appearance.\u00a0<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\">Inspect for <strong>bugs<\/strong> and insect bites. Ensure you inspect the crevices of the external ear and behind the ears.<\/span>\r\n<ul>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Normally, no bugs or bites are present.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">If bugs or bites are present, note the location and appearance. For example, lice are bugs that are commonly found among school-age children and are often observed behind the ears.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\">Inspect the external auditory meatus and canal for <strong>discharge<\/strong>, <strong>swelling<\/strong>, <strong>discolouration (erythema)<\/strong>, and <strong>foreign objects<\/strong>.<\/span>\r\n<ul>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Normally, no discharge, swelling, discolouration, or foreign object are present.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">If you observe discharge, swelling, or discolouration, note the appearance (colour), quantity, and location, including which ear. If a foreign object is present, describe the appearance and location, including which ear.\u00a0<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\">Inspect for the presence of <strong>earwax<\/strong>.<\/span>\r\n<ul>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Normally, some or no earwax is present.\u00a0<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">If earwax is present, note the colour, texture, and quantity.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Note the <strong>findings<\/strong>:<\/span>\r\n<ul>\r\n \t<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\"><strong>Normal findings<\/strong> might be documented as: \u201cEars symmetrical and intact with no lesions, deformities, discolouration, swelling, bugs, discharge, foreign objects, or earwax.\u201d<\/span><\/li>\r\n \t<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\"><strong>Abnormal findings<\/strong> might be documented as: \u201cLeft auditory meatus is red and swollen with a yellow sticky discharge\u201d or \u201cScaly skin rash posterior to right ear\u201d (see example of <a href=\"https:\/\/www.blackandbrownskin.co.uk\/headandneck\/post-auricular-eczema\" target=\"_blank\" rel=\"noopener\">postauricular eczema<\/a>). See <strong>Figures 9<\/strong>, <strong>10<\/strong>, and <strong>11<\/strong>\u00a0for images of an ear infection with discharge.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ol>\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-6-Ulcer-271x300.png\" alt=\"\" width=\"271\" height=\"300\" class=\"size-medium wp-image-3053 aligncenter\" \/>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 7<\/strong>: Ulcer. (By Paul D.R. Johnson, Joseph Azuolas, Caroline J. Lavender, Elwyn Wishart, Timothy P. Stinear, John A. Hayman, Lynne Brown, Grant A. Jenkin, and Janet A.M. Fyfe. - Mycobacterium ulcerans in Mosquitoes Captured during Outbreak of Buruli Ulcer, Southeastern Australia. Emerging Infectious Diseases, Volume 13, Number 11.,\u00a0<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">This image is a work of the<\/span> <a href=\"https:\/\/en.wikipedia.org\/wiki\/en:Centers_for_Disease_Control_and_Prevention\" target=\"_blank\" rel=\"noopener\">Centers for Disease Control and Prevention<\/a><span style=\"color: #000000\">, part of the<\/span> <a href=\"https:\/\/en.wikipedia.org\/wiki\/en:United_States_Department_of_Health_and_Human_Services\" target=\"_blank\" rel=\"noopener\">United States Department of Health and Human Services<\/a><span style=\"color: #000000\">, taken or made as part of an employee's official duties. As a work of the<\/span> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Federal_Government_of_the_United_States\" target=\"_blank\" rel=\"noopener\">U.S. federal government<\/a><span style=\"color: #000000\">, the image is in the <\/span><a href=\"https:\/\/en.wikipedia.org\/wiki\/public_domain\" target=\"_blank\" rel=\"noopener\">public domain<\/a><span style=\"color: #000000\">,<\/span><\/p>\r\n<p style=\"text-align: left\"><a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=34972908\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=34972908<\/a><span style=\"color: #000000\">)<\/span><\/p>\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/10\/Erythema-Ear--202x300.jpeg\" alt=\"\" width=\"202\" height=\"300\" class=\"alignnone size-medium wp-image-3532\" \/> <img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-7-Erythema-220x300.png\" alt=\"\" width=\"220\" height=\"300\" class=\"alignnone size-medium wp-image-3054\" \/>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 8<\/strong>: Erythema. (Left image by <span>Tayiba Rahman, CC BY NC. Right image b<\/span>y Giorgio Lambru, Sarah Miller and Manjit S Matharu - \"The red ear syndrome\", The Journal of Headache and Pain 2013, 14:83. doi: 10.1186\/1129-2377-14-83, CC BY 2.0,<\/span> <a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=40946332\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=40946332<\/a><span style=\"color: #000000\">)<\/span><\/p>\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figures-8-Ear-infection-213x300.png\" alt=\"\" width=\"193\" height=\"272\" class=\"alignnone wp-image-3055\" \/> <img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figures-9-Ear-infection-300x226.png\" alt=\"\" width=\"250\" height=\"188\" class=\"alignnone wp-image-3056\" \/> <img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figures-10-Ear-infection-235x300.png\" alt=\"\" width=\"202\" height=\"258\" class=\"alignnone wp-image-3057\" \/>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figures 9<\/strong>, <strong>10<\/strong>, and <strong>11<\/strong>: Ear infection (external otitis [swimmer\u2019s ear]).<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 9<\/strong>: (By Grook Da Oger - Own work,<\/span> <a href=\"https:\/\/en.wikipedia.org\/wiki\/en:Creative_Commons\" target=\"_blank\" rel=\"noopener\">Creative Commons<\/a> <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/3.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Attribution-Share Alike 3.0 Unported<\/a> <span style=\"color: #000000\">license,<\/span> <a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=16079610\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=16079610<\/a>)<\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 10<\/strong>: External otitis. (By Klaus D. Peter, Wiehl, Germany - Own work,<\/span> <a href=\"https:\/\/en.wikipedia.org\/wiki\/en:Creative_Commons\" target=\"_blank\" rel=\"noopener\">Creative Commons<\/a> <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\/de\/deed.en\" target=\"_blank\" rel=\"noopener\">Attribution 3.0 Germany<\/a> <span style=\"color: #000000\">license,<\/span> <a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=9655043\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=9655043<\/a><span style=\"color: #000000\">)<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 11<\/strong>: External otitis - severe case (By James Heilman, MD - Own work, <\/span><a href=\"https:\/\/en.wikipedia.org\/wiki\/en:Creative_Commons\" target=\"_blank\" rel=\"noopener\">Creative Commons<\/a> <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Attribution 3.0 Unported<\/a> <span style=\"color: #000000\">license,<\/span> <a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=10313999\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=10313999<\/a><span style=\"color: #000000\">)<\/span><\/p>\r\n&nbsp;\r\n\r\n[embed]https:\/\/youtu.be\/8QKptO8svyI[\/embed]\r\n\r\n<span style=\"color: #000000\"><strong>Video 1<\/strong>: Ear inspection. [0.59 seconds].<\/span>\r\n\r\n&nbsp;\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Steps for <strong>palpation<\/strong> include (see <strong>Video 2<\/strong>):<\/span><\/p>\r\n\r\n<ol>\r\n \t<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\">Assess one ear at a time. Ask the client if they have any <strong>pain<\/strong> as you gently pull the helix upwards and the lobe downwards, and then push on the tragus and the mastoid process.\u00a0<\/span>\r\n<ul>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Normal findings are no pain.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Pain is an abnormal finding. If pain is present, assess with the PQRSTU mnemonic.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\">Gently palpate and describe any <strong>lumps<\/strong> or <strong>deformities<\/strong> that you observed.\u00a0<\/span>\r\n<ul>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Normally, no lumps or deformities are present.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">If a lump or deformity is present, ask the client if it is painful and measure its size, and note any signs of infection such as erythema and swelling. Describe the following characteristics: location on ear(s), colour, texture (smooth, rough, dotted), consistency (soft, firm), and mobility (moveable, fixed).\u00a0<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Note the <strong>findings<\/strong>:<\/span>\r\n<ul>\r\n \t<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\"><strong>Normal findings<\/strong> might be documented as: \u201cClient reports no pain when palpating the ear, and no lumps or deformities.\u201d<\/span><\/li>\r\n \t<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\"><strong>Abnormal findings<\/strong> might be documented as: \u201cFirm, rubbery lump at back of ear lobe, 2x2 centimetres. Colour consistent with client\u2019s face.\u201d<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ol>\r\n&nbsp;\r\n\r\n[embed]https:\/\/youtu.be\/2wJWep9bcAU[\/embed]\r\n\r\n<span style=\"color: #000000\"><strong>Video 2<\/strong>: Ear palpation. [0.26 seconds].<\/span>\r\n\r\n&nbsp;\r\n<div class=\"textbox shaded\">\r\n<h2 style=\"text-align: center\"><span style=\"color: #000000\"><strong>Contextualizing Inclusivity<\/strong><\/span><\/h2>\r\n<span style=\"color: #000000\">If a client has <strong>ear jewelry<\/strong>, assess for any signs of infection, which can result from non-sterile piercing approaches. Remember to critically reflect on your biases related to ear jewelry: you are likely to observe various types and quantities of ear jewelry on many parts of the ear. Earlobes are a common location, but you may observe jewelry on other areas such as the cartilage of the upper ear and also on the tragus. Some clients may have stretched their ear-piercing holes to accommodate spacers (large round jewelry), <strong>Figures 12<\/strong>, <strong>13<\/strong>, and <strong>14<\/strong>. Ear-piercings may be related to culture and spirituality; they are common among women, but may be observed among people of all genders and ages. For example, people of South Asian and Southeast Asian heritage often have their ears pierced before the age of one (Anwar, 2024). Reflect on your own biases and ensure a non-judgemental approach.<\/span>\r\n\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/sneha-cecil-XNs-qGCVVoI-unsplash-177x300.jpg\" alt=\"\" width=\"111\" height=\"188\" class=\"alignnone wp-image-3080\" \/>\u00a0<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Young_woman_with_stretched_ear_piercing-300x284.jpg\" alt=\"\" width=\"200\" height=\"189\" class=\"alignnone wp-image-3081\" \/>\u00a0<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Modified_Ear-300x228.jpg\" alt=\"\" width=\"246\" height=\"187\" class=\"alignnone wp-image-3079\" \/>\r\n\r\n<span style=\"color: #000000\"><strong>Figure 12:<\/strong> Photo by<\/span> <span style=\"color: #0000ff\"><a href=\"https:\/\/unsplash.com\/@sneha_snaps?utm_content=creditCopyText&amp;utm_medium=referral&amp;utm_source=unsplash\" style=\"color: #0000ff\" target=\"_blank\" rel=\"noopener\">Sneha Cecil<\/a><\/span> <span style=\"color: #000000\">on <\/span><span style=\"color: #0000ff\"><a href=\"https:\/\/unsplash.com\/photos\/smiling-man-standing-and-facing-his-right-side-XNs-qGCVVoI?utm_content=creditCopyText&amp;utm_medium=referral&amp;utm_source=unsplash\" style=\"color: #0000ff\" target=\"_blank\" rel=\"noopener\">Unsplash<\/a><\/span>\r\n\r\n<span style=\"color: #000000\"><strong>Figure 13:<\/strong> By Gabriele from Bologna, ITALY - lobe stretching xxl, CC BY 2.0,<\/span> <span style=\"color: #0000ff\"><a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=5246354\" style=\"color: #0000ff\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=5246354<\/a><\/span>\r\n\r\n<span style=\"color: #000000\"><strong>Figure 14:<\/strong> By Lish Daelnar - Lish Daelnar, http:\/\/compunction.org, CC BY 3.0 us,<\/span> <span style=\"color: #0000ff\"><a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=4733704\" style=\"color: #0000ff\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=4733704<\/a><\/span>\r\n\r\n&nbsp;\r\n\r\n<span style=\"color: #000000\">In young children, it is important to assess the presence and size of ears. <strong>Microtia<\/strong> is a congenital deformity of an incompletely formed external ear in which the ear is smaller and sometimes has missing or deformed key features, or the outer ear may be missing altogether (see <strong>Figure 15<\/strong>). <strong>Macrotia<\/strong> is another congenital deformity in which the external ear is larger than normal and not in proportion to the head; it may be longer and\/or wider than normal.<\/span>\r\n\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Microtia_lvl3.jpg\" alt=\"\" width=\"240\" height=\"180\" class=\"size-full wp-image-3082 aligncenter\" \/>\r\n\r\n<span style=\"color: #000000\"><strong>Figure 15:<\/strong> Microtia. (By Mulgamutt at English Wikipedia - Transferred from en.wikipedia to Commons by Filip em using CommonsHelper., Public Domain,<\/span> <span style=\"color: #0000ff\"><a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=4120960\" style=\"color: #0000ff\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=4120960<\/a><\/span><span style=\"color: #000000\">)<\/span>\r\n\r\n<\/div>\r\n<div class=\"textbox textbox--learning-objectives\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\" style=\"text-align: center\"><strong>Priorities of Care<\/strong><\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\n<span style=\"color: #000000\">Report all abnormal findings to the physician or nurse practitioner.<\/span>\r\n<ul>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Erythema, swelling, and discharge are signs of infection and should be reported promptly: an infection needs treatment so it doesn\u2019t lead to permanent damage such as hearing impairment. If the client shows signs of ear infection and\/or pain, assess the head and neck lymph nodes: <a href=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/inspection-and-palpation-of-the-lymph-nodes\/\" target=\"_blank\" rel=\"noopener\">inspection and palpation process.<\/a><\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Any foreign objects should also be reported promptly. For example, a child might put a small disc battery (button battery) in their ear. This requires immediate action and should be reported immediately, as moisture in the ear can quickly cause batteries to release chemicals, leading to chemical burns, tissue necrosis, tympanic perforation, and\/or hearing impairment.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">If a client presents with hypothermia due to extreme cold exposure, assess for findings related to frostbite, which can present as a range of red, purple, pale, blue, and black shades. Assess for pain and paresthesia and numbness or lack of sensation in particular. Slowly rewarm the ears to protect the skin.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Findings such as lesions should be reported promptly, as they may suggest potential carcinoma. Some clients may tell you they have noticed an open sore that has developed with no physical trauma and has not healed. Any sore that doesn\u2019t heal should be of concern: the healing process depends on the type and severity of the sore, but a typical timeframe to heal is 4 to 6 weeks. Lesions are not a critical finding that require immediate action, but they can be life-threatening and require prompt intervention because they may be curable if diagnosed and treated early.<\/span><\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<h2><span style=\"color: #000000\">Activity: Check Your Understanding<\/span><\/h2>\r\n<div class=\"postbox h5p-sidebar\">\r\n<div class=\"h5p-action-bar-settings h5p-panel\">\r\n<div class=\"postbox h5p-sidebar\">\r\n<div class=\"h5p-action-bar-settings h5p-panel\"><span style=\"color: #000000\">[h5p id=\"251\"]<\/span><\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<div><\/div>\r\n<h1><span style=\"color: #000000\">References<\/span><\/h1>\r\n<span style=\"color: #000000\">Anwar, A. (2024). The cultural significance and meaning of ear piercing tradition. <\/span><a href=\"https:\/\/heyrowan.com\/blogs\/hey-rowan\/how-ear-body-piercing-relates-to-culture-and-tradition\" target=\"_blank\" rel=\"noopener\">https:\/\/heyrowan.com\/blogs\/hey-rowan\/how-ear-body-piercing-relates-to-culture-and-tradition<\/a>\r\n<div class=\"postbox h5p-sidebar\">\r\n<div class=\"postbox h5p-sidebar\"><\/div>\r\n<\/div>","rendered":"<p style=\"text-align: left\"><span style=\"color: #000000\">Inspection and palpation of the external ear can be done with the client in any position, but is typically completed with the client sitting in an upright position.\u00a0<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Steps of <strong>inspection<\/strong> include (see <strong>Video 1<\/strong>):<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Inspect <strong>symmetry<\/strong>, <strong>lesions<\/strong>, and <strong>deformities<\/strong> on or around the ears.<\/span>\n<ul>\n<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\">Normally, the ears are symmetrical with no lesions or deformities. However, one common and normal ear lesion is Darwin&#8217;s tubercle (a thickening of or nodule on the middle to upper portion of the helix) (<strong>Figure 3<\/strong>).\u00a0<\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">In some congenital abnormalities, one ear is significantly smaller or larger, or parts of an ear or the whole ear is not present. Another common deformity is cauliflower ear (<strong>Figure 4<\/strong>) caused by a physical trauma to the ear such as a sports injury: disruption to the blood supply causes inflammation and cartilage overgrowth, resulting in a deformity that has the textured appearance of a cauliflower. Ear keloids (<strong>Figure 5<\/strong> and <strong>6<\/strong>) are also a common deformity: these are nodules that can range in size and are firm and rubbery, often caused by minor trauma and scar tissue formation such as with ear-piercing. Ear keloids usually have the same colour as the client\u2019s skin, but can also appear as shades of pink, red, and purple.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/12\/Darwins-tubercle-207x300.png\" alt=\"Shows a small nodule on the ear's helix\" width=\"207\" height=\"300\" class=\"size-medium wp-image-3616 aligncenter\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/12\/Darwins-tubercle-207x300.png 207w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/12\/Darwins-tubercle-706x1024.png 706w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/12\/Darwins-tubercle-768x1114.png 768w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/12\/Darwins-tubercle-1059x1536.png 1059w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/12\/Darwins-tubercle-1412x2048.png 1412w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/12\/Darwins-tubercle-65x94.png 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/12\/Darwins-tubercle-225x326.png 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/12\/Darwins-tubercle-350x508.png 350w\" sizes=\"auto, (max-width: 207px) 100vw, 207px\" \/><\/p>\n<p><span style=\"color: #000000\"><strong>Figure 3<\/strong>: Darwin&#8217;s tubercle.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-3-Cauliflower-ear.png\" alt=\"\" width=\"215\" height=\"288\" class=\"wp-image-3050 aligncenter\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-3-Cauliflower-ear.png 154w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-3-Cauliflower-ear-65x87.png 65w\" sizes=\"auto, (max-width: 215px) 100vw, 215px\" \/><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 4<\/strong>: Cauliflower ear.\u00a0(From:<\/span> <a href=\"https:\/\/jetem.org\/cauliflower_ear\/cauliflower-ear-photograph-1-jetem-2018\/\" target=\"_blank\" rel=\"noopener\">https:\/\/jetem.org\/cauliflower_ear\/cauliflower-ear-photograph-1-jetem-2018\/<\/a> <span style=\"color: #000000\">Cauliflower Ear. Photograph 1. JETem 2018 6. This work is licensed under a <\/span><a href=\"http:\/\/creativecommons.org\/licenses\/by\/4.0\/\" target=\"_blank\" rel=\"noopener\">Creative Commons Attribution 4.0 International License<\/a><span style=\"color: #000000\">).<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-4-Ear-keloid.png\" alt=\"\" width=\"297\" height=\"198\" class=\"wp-image-3051 aligncenter\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-4-Ear-keloid.png 255w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-4-Ear-keloid-65x43.png 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-4-Ear-keloid-225x150.png 225w\" sizes=\"auto, (max-width: 297px) 100vw, 297px\" \/><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 5<\/strong>: Ear keloid. (By Htirgan, This file is licensed under the <\/span><a href=\"https:\/\/en.wikipedia.org\/wiki\/en:Creative_Commons\" target=\"_blank\" rel=\"noopener\">Creative Commons<\/a> <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/3.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Attribution-Share Alike 3.0 Unported<\/a> <span style=\"color: #000000\">license,<\/span> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Earlobe_Keloid,_Bulky.JPG\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.org\/wiki\/File:Earlobe_Keloid,_Bulky.JPG<\/a><span style=\"color: #000000\">)<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-5-Ear-keloid-300x200.png\" alt=\"\" width=\"300\" height=\"200\" class=\"size-medium wp-image-3052 aligncenter\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-5-Ear-keloid-300x200.png 300w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-5-Ear-keloid-65x43.png 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-5-Ear-keloid-225x150.png 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-5-Ear-keloid-350x234.png 350w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-5-Ear-keloid.png 385w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 6<\/strong>: Ear keloid (right image). By Htirgan &#8211; Own work,<\/span> <a href=\"https:\/\/en.wikipedia.org\/wiki\/en:Creative_Commons\" target=\"_blank\" rel=\"noopener\">Creative Commons<\/a> <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/3.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Attribution-Share Alike 3.0 Unported<\/a><span style=\"color: #000000\"> license,<\/span> <a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=32782666\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=32782666<\/a><\/p>\n<ol start=\"2\">\n<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\">Inspect for<strong> skin integrity<\/strong>, <strong>colour<\/strong>, and <strong>swelling<\/strong> on and around the ears.<\/span>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Normally, the skin is intact with no signs of discolouration or swelling. If piercings are present, assess for and describe any signs of infection such as erythema and swelling.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Abnormal findings may include skin that is not intact such as an open ulcer (<strong>Figure 7<\/strong>) or the presence of scars. Discolouration of the ear from the client\u2019s baseline is important to evaluate such as erythema (<strong>Figure 8<\/strong>) and swollen or darker than the client\u2019s baseline skin colour including shades of purple and blue and turning very black. If present, describe the location and appearance.\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\">Inspect for <strong>bugs<\/strong> and insect bites. Ensure you inspect the crevices of the external ear and behind the ears.<\/span>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Normally, no bugs or bites are present.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">If bugs or bites are present, note the location and appearance. For example, lice are bugs that are commonly found among school-age children and are often observed behind the ears.<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\">Inspect the external auditory meatus and canal for <strong>discharge<\/strong>, <strong>swelling<\/strong>, <strong>discolouration (erythema)<\/strong>, and <strong>foreign objects<\/strong>.<\/span>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Normally, no discharge, swelling, discolouration, or foreign object are present.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">If you observe discharge, swelling, or discolouration, note the appearance (colour), quantity, and location, including which ear. If a foreign object is present, describe the appearance and location, including which ear.\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\">Inspect for the presence of <strong>earwax<\/strong>.<\/span>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Normally, some or no earwax is present.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">If earwax is present, note the colour, texture, and quantity.<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Note the <strong>findings<\/strong>:<\/span>\n<ul>\n<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\"><strong>Normal findings<\/strong> might be documented as: \u201cEars symmetrical and intact with no lesions, deformities, discolouration, swelling, bugs, discharge, foreign objects, or earwax.\u201d<\/span><\/li>\n<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\"><strong>Abnormal findings<\/strong> might be documented as: \u201cLeft auditory meatus is red and swollen with a yellow sticky discharge\u201d or \u201cScaly skin rash posterior to right ear\u201d (see example of <a href=\"https:\/\/www.blackandbrownskin.co.uk\/headandneck\/post-auricular-eczema\" target=\"_blank\" rel=\"noopener\">postauricular eczema<\/a>). See <strong>Figures 9<\/strong>, <strong>10<\/strong>, and <strong>11<\/strong>\u00a0for images of an ear infection with discharge.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-6-Ulcer-271x300.png\" alt=\"\" width=\"271\" height=\"300\" class=\"size-medium wp-image-3053 aligncenter\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-6-Ulcer-271x300.png 271w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-6-Ulcer-65x72.png 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-6-Ulcer-225x249.png 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-6-Ulcer.png 278w\" sizes=\"auto, (max-width: 271px) 100vw, 271px\" \/><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 7<\/strong>: Ulcer. (By Paul D.R. Johnson, Joseph Azuolas, Caroline J. Lavender, Elwyn Wishart, Timothy P. Stinear, John A. Hayman, Lynne Brown, Grant A. Jenkin, and Janet A.M. Fyfe. &#8211; Mycobacterium ulcerans in Mosquitoes Captured during Outbreak of Buruli Ulcer, Southeastern Australia. Emerging Infectious Diseases, Volume 13, Number 11.,\u00a0<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">This image is a work of the<\/span> <a href=\"https:\/\/en.wikipedia.org\/wiki\/en:Centers_for_Disease_Control_and_Prevention\" target=\"_blank\" rel=\"noopener\">Centers for Disease Control and Prevention<\/a><span style=\"color: #000000\">, part of the<\/span> <a href=\"https:\/\/en.wikipedia.org\/wiki\/en:United_States_Department_of_Health_and_Human_Services\" target=\"_blank\" rel=\"noopener\">United States Department of Health and Human Services<\/a><span style=\"color: #000000\">, taken or made as part of an employee&#8217;s official duties. As a work of the<\/span> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Federal_Government_of_the_United_States\" target=\"_blank\" rel=\"noopener\">U.S. federal government<\/a><span style=\"color: #000000\">, the image is in the <\/span><a href=\"https:\/\/en.wikipedia.org\/wiki\/public_domain\" target=\"_blank\" rel=\"noopener\">public domain<\/a><span style=\"color: #000000\">,<\/span><\/p>\n<p style=\"text-align: left\"><a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=34972908\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=34972908<\/a><span style=\"color: #000000\">)<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/10\/Erythema-Ear--202x300.jpeg\" alt=\"\" width=\"202\" height=\"300\" class=\"alignnone size-medium wp-image-3532\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/10\/Erythema-Ear--202x300.jpeg 202w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/10\/Erythema-Ear--688x1024.jpeg 688w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/10\/Erythema-Ear--768x1142.jpeg 768w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/10\/Erythema-Ear--1033x1536.jpeg 1033w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/10\/Erythema-Ear--65x97.jpeg 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/10\/Erythema-Ear--225x335.jpeg 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/10\/Erythema-Ear--350x521.jpeg 350w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/10\/Erythema-Ear-.jpeg 1280w\" sizes=\"auto, (max-width: 202px) 100vw, 202px\" \/> <img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-7-Erythema-220x300.png\" alt=\"\" width=\"220\" height=\"300\" class=\"alignnone size-medium wp-image-3054\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-7-Erythema-220x300.png 220w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-7-Erythema-65x88.png 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-7-Erythema-225x306.png 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figure-7-Erythema.png 249w\" sizes=\"auto, (max-width: 220px) 100vw, 220px\" \/><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 8<\/strong>: Erythema. (Left image by <span>Tayiba Rahman, CC BY NC. Right image b<\/span>y Giorgio Lambru, Sarah Miller and Manjit S Matharu &#8211; &#8220;The red ear syndrome&#8221;, The Journal of Headache and Pain 2013, 14:83. doi: 10.1186\/1129-2377-14-83, CC BY 2.0,<\/span> <a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=40946332\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=40946332<\/a><span style=\"color: #000000\">)<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figures-8-Ear-infection-213x300.png\" alt=\"\" width=\"193\" height=\"272\" class=\"alignnone wp-image-3055\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figures-8-Ear-infection-213x300.png 213w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figures-8-Ear-infection-65x92.png 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figures-8-Ear-infection.png 222w\" sizes=\"auto, (max-width: 193px) 100vw, 193px\" \/> <img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figures-9-Ear-infection-300x226.png\" alt=\"\" width=\"250\" height=\"188\" class=\"alignnone wp-image-3056\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figures-9-Ear-infection-300x226.png 300w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figures-9-Ear-infection-65x49.png 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figures-9-Ear-infection-225x169.png 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figures-9-Ear-infection.png 304w\" sizes=\"auto, (max-width: 250px) 100vw, 250px\" \/> <img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figures-10-Ear-infection-235x300.png\" alt=\"\" width=\"202\" height=\"258\" class=\"alignnone wp-image-3057\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figures-10-Ear-infection-235x300.png 235w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figures-10-Ear-infection-65x83.png 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figures-10-Ear-infection-225x288.png 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Figures-10-Ear-infection.png 258w\" sizes=\"auto, (max-width: 202px) 100vw, 202px\" \/><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figures 9<\/strong>, <strong>10<\/strong>, and <strong>11<\/strong>: Ear infection (external otitis [swimmer\u2019s ear]).<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 9<\/strong>: (By Grook Da Oger &#8211; Own work,<\/span> <a href=\"https:\/\/en.wikipedia.org\/wiki\/en:Creative_Commons\" target=\"_blank\" rel=\"noopener\">Creative Commons<\/a> <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/3.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Attribution-Share Alike 3.0 Unported<\/a> <span style=\"color: #000000\">license,<\/span> <a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=16079610\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=16079610<\/a>)<\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 10<\/strong>: External otitis. (By Klaus D. Peter, Wiehl, Germany &#8211; Own work,<\/span> <a href=\"https:\/\/en.wikipedia.org\/wiki\/en:Creative_Commons\" target=\"_blank\" rel=\"noopener\">Creative Commons<\/a> <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\/de\/deed.en\" target=\"_blank\" rel=\"noopener\">Attribution 3.0 Germany<\/a> <span style=\"color: #000000\">license,<\/span> <a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=9655043\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=9655043<\/a><span style=\"color: #000000\">)<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 11<\/strong>: External otitis &#8211; severe case (By James Heilman, MD &#8211; Own work, <\/span><a href=\"https:\/\/en.wikipedia.org\/wiki\/en:Creative_Commons\" target=\"_blank\" rel=\"noopener\">Creative Commons<\/a> <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\/deed.en\" target=\"_blank\" rel=\"noopener\">Attribution 3.0 Unported<\/a> <span style=\"color: #000000\">license,<\/span> <a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=10313999\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=10313999<\/a><span style=\"color: #000000\">)<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-1\" title=\"Ear Inspection.\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/8QKptO8svyI?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><span style=\"color: #000000\"><strong>Video 1<\/strong>: Ear inspection. [0.59 seconds].<\/span><\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Steps for <strong>palpation<\/strong> include (see <strong>Video 2<\/strong>):<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\">Assess one ear at a time. Ask the client if they have any <strong>pain<\/strong> as you gently pull the helix upwards and the lobe downwards, and then push on the tragus and the mastoid process.\u00a0<\/span>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Normal findings are no pain.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Pain is an abnormal finding. If pain is present, assess with the PQRSTU mnemonic.<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\">Gently palpate and describe any <strong>lumps<\/strong> or <strong>deformities<\/strong> that you observed.\u00a0<\/span>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Normally, no lumps or deformities are present.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">If a lump or deformity is present, ask the client if it is painful and measure its size, and note any signs of infection such as erythema and swelling. Describe the following characteristics: location on ear(s), colour, texture (smooth, rough, dotted), consistency (soft, firm), and mobility (moveable, fixed).\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Note the <strong>findings<\/strong>:<\/span>\n<ul>\n<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\"><strong>Normal findings<\/strong> might be documented as: \u201cClient reports no pain when palpating the ear, and no lumps or deformities.\u201d<\/span><\/li>\n<li style=\"font-weight: 400;text-align: left\"><span style=\"color: #000000\"><strong>Abnormal findings<\/strong> might be documented as: \u201cFirm, rubbery lump at back of ear lobe, 2&#215;2 centimetres. Colour consistent with client\u2019s face.\u201d<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-2\" title=\"Ear Palpation.\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/2wJWep9bcAU?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><span style=\"color: #000000\"><strong>Video 2<\/strong>: Ear palpation. [0.26 seconds].<\/span><\/p>\n<p>&nbsp;<\/p>\n<div class=\"textbox shaded\">\n<h2 style=\"text-align: center\"><span style=\"color: #000000\"><strong>Contextualizing Inclusivity<\/strong><\/span><\/h2>\n<p><span style=\"color: #000000\">If a client has <strong>ear jewelry<\/strong>, assess for any signs of infection, which can result from non-sterile piercing approaches. Remember to critically reflect on your biases related to ear jewelry: you are likely to observe various types and quantities of ear jewelry on many parts of the ear. Earlobes are a common location, but you may observe jewelry on other areas such as the cartilage of the upper ear and also on the tragus. Some clients may have stretched their ear-piercing holes to accommodate spacers (large round jewelry), <strong>Figures 12<\/strong>, <strong>13<\/strong>, and <strong>14<\/strong>. Ear-piercings may be related to culture and spirituality; they are common among women, but may be observed among people of all genders and ages. For example, people of South Asian and Southeast Asian heritage often have their ears pierced before the age of one (Anwar, 2024). Reflect on your own biases and ensure a non-judgemental approach.<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/sneha-cecil-XNs-qGCVVoI-unsplash-177x300.jpg\" alt=\"\" width=\"111\" height=\"188\" class=\"alignnone wp-image-3080\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/sneha-cecil-XNs-qGCVVoI-unsplash-177x300.jpg 177w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/sneha-cecil-XNs-qGCVVoI-unsplash-604x1024.jpg 604w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/sneha-cecil-XNs-qGCVVoI-unsplash-768x1303.jpg 768w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/sneha-cecil-XNs-qGCVVoI-unsplash-905x1536.jpg 905w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/sneha-cecil-XNs-qGCVVoI-unsplash-1207x2048.jpg 1207w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/sneha-cecil-XNs-qGCVVoI-unsplash-65x110.jpg 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/sneha-cecil-XNs-qGCVVoI-unsplash-225x382.jpg 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/sneha-cecil-XNs-qGCVVoI-unsplash-350x594.jpg 350w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/sneha-cecil-XNs-qGCVVoI-unsplash-scaled.jpg 1509w\" sizes=\"auto, (max-width: 111px) 100vw, 111px\" \/>\u00a0<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Young_woman_with_stretched_ear_piercing-300x284.jpg\" alt=\"\" width=\"200\" height=\"189\" class=\"alignnone wp-image-3081\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Young_woman_with_stretched_ear_piercing-300x284.jpg 300w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Young_woman_with_stretched_ear_piercing-65x61.jpg 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Young_woman_with_stretched_ear_piercing-225x213.jpg 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Young_woman_with_stretched_ear_piercing-350x331.jpg 350w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Young_woman_with_stretched_ear_piercing.jpg 682w\" sizes=\"auto, (max-width: 200px) 100vw, 200px\" \/>\u00a0<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Modified_Ear-300x228.jpg\" alt=\"\" width=\"246\" height=\"187\" class=\"alignnone wp-image-3079\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Modified_Ear-300x228.jpg 300w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Modified_Ear-65x49.jpg 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Modified_Ear-225x171.jpg 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Modified_Ear-350x266.jpg 350w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Modified_Ear.jpg 448w\" sizes=\"auto, (max-width: 246px) 100vw, 246px\" \/><\/p>\n<p><span style=\"color: #000000\"><strong>Figure 12:<\/strong> Photo by<\/span> <span style=\"color: #0000ff\"><a href=\"https:\/\/unsplash.com\/@sneha_snaps?utm_content=creditCopyText&amp;utm_medium=referral&amp;utm_source=unsplash\" style=\"color: #0000ff\" target=\"_blank\" rel=\"noopener\">Sneha Cecil<\/a><\/span> <span style=\"color: #000000\">on <\/span><span style=\"color: #0000ff\"><a href=\"https:\/\/unsplash.com\/photos\/smiling-man-standing-and-facing-his-right-side-XNs-qGCVVoI?utm_content=creditCopyText&amp;utm_medium=referral&amp;utm_source=unsplash\" style=\"color: #0000ff\" target=\"_blank\" rel=\"noopener\">Unsplash<\/a><\/span><\/p>\n<p><span style=\"color: #000000\"><strong>Figure 13:<\/strong> By Gabriele from Bologna, ITALY &#8211; lobe stretching xxl, CC BY 2.0,<\/span> <span style=\"color: #0000ff\"><a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=5246354\" style=\"color: #0000ff\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=5246354<\/a><\/span><\/p>\n<p><span style=\"color: #000000\"><strong>Figure 14:<\/strong> By Lish Daelnar &#8211; Lish Daelnar, http:\/\/compunction.org, CC BY 3.0 us,<\/span> <span style=\"color: #0000ff\"><a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=4733704\" style=\"color: #0000ff\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=4733704<\/a><\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"color: #000000\">In young children, it is important to assess the presence and size of ears. <strong>Microtia<\/strong> is a congenital deformity of an incompletely formed external ear in which the ear is smaller and sometimes has missing or deformed key features, or the outer ear may be missing altogether (see <strong>Figure 15<\/strong>). <strong>Macrotia<\/strong> is another congenital deformity in which the external ear is larger than normal and not in proportion to the head; it may be longer and\/or wider than normal.<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Microtia_lvl3.jpg\" alt=\"\" width=\"240\" height=\"180\" class=\"size-full wp-image-3082 aligncenter\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Microtia_lvl3.jpg 240w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Microtia_lvl3-65x49.jpg 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/08\/Microtia_lvl3-225x169.jpg 225w\" sizes=\"auto, (max-width: 240px) 100vw, 240px\" \/><\/p>\n<p><span style=\"color: #000000\"><strong>Figure 15:<\/strong> Microtia. (By Mulgamutt at English Wikipedia &#8211; Transferred from en.wikipedia to Commons by Filip em using CommonsHelper., Public Domain,<\/span> <span style=\"color: #0000ff\"><a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=4120960\" style=\"color: #0000ff\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=4120960<\/a><\/span><span style=\"color: #000000\">)<\/span><\/p>\n<\/div>\n<div class=\"textbox textbox--learning-objectives\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\" style=\"text-align: center\"><strong>Priorities of Care<\/strong><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<p><span style=\"color: #000000\">Report all abnormal findings to the physician or nurse practitioner.<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Erythema, swelling, and discharge are signs of infection and should be reported promptly: an infection needs treatment so it doesn\u2019t lead to permanent damage such as hearing impairment. If the client shows signs of ear infection and\/or pain, assess the head and neck lymph nodes: <a href=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/inspection-and-palpation-of-the-lymph-nodes\/\" target=\"_blank\" rel=\"noopener\">inspection and palpation process.<\/a><\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Any foreign objects should also be reported promptly. For example, a child might put a small disc battery (button battery) in their ear. This requires immediate action and should be reported immediately, as moisture in the ear can quickly cause batteries to release chemicals, leading to chemical burns, tissue necrosis, tympanic perforation, and\/or hearing impairment.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">If a client presents with hypothermia due to extreme cold exposure, assess for findings related to frostbite, which can present as a range of red, purple, pale, blue, and black shades. Assess for pain and paresthesia and numbness or lack of sensation in particular. Slowly rewarm the ears to protect the skin.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Findings such as lesions should be reported promptly, as they may suggest potential carcinoma. Some clients may tell you they have noticed an open sore that has developed with no physical trauma and has not healed. Any sore that doesn\u2019t heal should be of concern: the healing process depends on the type and severity of the sore, but a typical timeframe to heal is 4 to 6 weeks. Lesions are not a critical finding that require immediate action, but they can be life-threatening and require prompt intervention because they may be curable if diagnosed and treated early.<\/span><\/li>\n<\/ul>\n<\/div>\n<\/div>\n<h2><span style=\"color: #000000\">Activity: Check Your Understanding<\/span><\/h2>\n<div class=\"postbox h5p-sidebar\">\n<div class=\"h5p-action-bar-settings h5p-panel\">\n<div class=\"postbox h5p-sidebar\">\n<div class=\"h5p-action-bar-settings h5p-panel\"><span style=\"color: #000000\"><\/p>\n<div id=\"h5p-251\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-251\" class=\"h5p-iframe\" data-content-id=\"251\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Inspection and Palpation of Ear H5P\"><\/iframe><\/div>\n<\/div>\n<p><\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div><\/div>\n<h1><span style=\"color: #000000\">References<\/span><\/h1>\n<p><span style=\"color: #000000\">Anwar, A. (2024). The cultural significance and meaning of ear piercing tradition. <\/span><a href=\"https:\/\/heyrowan.com\/blogs\/hey-rowan\/how-ear-body-piercing-relates-to-culture-and-tradition\" target=\"_blank\" rel=\"noopener\">https:\/\/heyrowan.com\/blogs\/hey-rowan\/how-ear-body-piercing-relates-to-culture-and-tradition<\/a><\/p>\n<div class=\"postbox h5p-sidebar\">\n<div class=\"postbox h5p-sidebar\"><\/div>\n<\/div>\n","protected":false},"author":34,"menu_order":5,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-2967","chapter","type-chapter","status-publish","hentry"],"part":2956,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/2967","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/users\/34"}],"version-history":[{"count":40,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/2967\/revisions"}],"predecessor-version":[{"id":3672,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/2967\/revisions\/3672"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/parts\/2956"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/2967\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/media?parent=2967"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapter-type?post=2967"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/contributor?post=2967"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/license?post=2967"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}