This includes an assessment of hearing as well
as the appearance of the ear.
as the appearance of the ear.
The following issues should be included:
v Classic
symptoms of ear disease: deafness, tinnitus discharge (otorrhoea) and vertiyo.
symptoms of ear disease: deafness, tinnitus discharge (otorrhoea) and vertiyo.
v Previous
ear surgery, or head injury.
ear surgery, or head injury.
v Family
history of deafness.
history of deafness.
v Systemic
disease (e.g. stroke, multiple sclerosis, cardiovascular disease).
disease (e.g. stroke, multiple sclerosis, cardiovascular disease).
v Ototoxic
drugs (antibiotics (e.g. gentamicin), diuretics, cytotoxics)
drugs (antibiotics (e.g. gentamicin), diuretics, cytotoxics)
v Exposure
to noise (e.g. pneumatic drill or shooting)
to noise (e.g. pneumatic drill or shooting)
v History
of atopy and allergy in children.
of atopy and allergy in children.
Inspecting
the External Ear
the External Ear
Inspect the external ear before examination with
an otoscope/auriscope. Swab any discharge and remove any wax. Look for obvious
signs of abnormality.
an otoscope/auriscope. Swab any discharge and remove any wax. Look for obvious
signs of abnormality.
v Size
and shape of the pinna.
and shape of the pinna.
v Extra
cartilage tags/pre-auricular sinuses or pits.
cartilage tags/pre-auricular sinuses or pits.
v Signs
of trauma to the pinna.
of trauma to the pinna.
v Suspicious
skin lesions on the pinna including neoplasia.
skin lesions on the pinna including neoplasia.
v Skin
conditions of the pinna and external canal
conditions of the pinna and external canal
v Infection/inflammation
of the external ear canal, with discharge.
of the external ear canal, with discharge.
v Signs/scars
of previous surgery.
of previous surgery.
Inspecting
The Ear Canal And Eardrum
The Ear Canal And Eardrum
A modern electric otoscope/auriscope with its
own light source is primarily used. An otoscope also has its own magnification
which gives a good view of the tympanic membrane.
own light source is primarily used. An otoscope also has its own magnification
which gives a good view of the tympanic membrane.
Examination
Technique
Technique
v This
involves grasping the pinna and pulling it up and backwards (posteriorly and
superiorly) which helps to straighten the ear canal and for inspection of the
TM.
involves grasping the pinna and pulling it up and backwards (posteriorly and
superiorly) which helps to straighten the ear canal and for inspection of the
TM.
v Hold
the otoscope near to the eyepiece rather than at the end, this helps to reduce
patient’s discomfort due to hand movements. Fit the correct size of speculum to
achieve best view; it is tempting to use a small piece for ease of inserting,
but this simply restricts the image available.
the otoscope near to the eyepiece rather than at the end, this helps to reduce
patient’s discomfort due to hand movements. Fit the correct size of speculum to
achieve best view; it is tempting to use a small piece for ease of inserting,
but this simply restricts the image available.
v NOTE:
The condition of the canal skin, and the presence of wax, foreign tissue, or
discharge.
The condition of the canal skin, and the presence of wax, foreign tissue, or
discharge.
Inspecting
The Tympanic Membrane
The Tympanic Membrane
Move the otoscope in order to see several
different views of the drum. The drum is roughly circular (~1cm diameter). In a
circular drum, the following structures can be identified.
different views of the drum. The drum is roughly circular (~1cm diameter). In a
circular drum, the following structures can be identified.
v Handle/Lateral
process of the malleus.
process of the malleus.
v Light
reflex/cone of light.
reflex/cone of light.
v Pars
tensa and pars flaccid (attic).
tensa and pars flaccid (attic).
Occasionally, in a healthy, thin drum, it is
possible to see the following:
possible to see the following:
v Long
process of incus
process of incus
v Chorda
tympani
tympani
v Eustachian
opening
opening
v Promontory
of the cochlea.
of the cochlea.
Common pathological conditions related to the
ear include.
ear include.
v Perforations
v Glue
ear/middle ear effusion
ear/middle ear effusion
v Refractions
of the drum
of the drum
v Blood
in the middle ear (haemotympanum)
in the middle ear (haemotympanum)
Basic
Hearing Tests
Hearing Tests
A patient with normal hearing should hear
equally as well in both ears.
equally as well in both ears.
Turning
Fort Tests
Fort Tests
This includes weber’s and Rinnes’s test.
Weber’s
Test
Test
This is performed in conjunction with Rinne’s
test. The vibrating fork is placed in the middle of the forehead and the
patient is asked whether any sound is heard, and if so, whether it is equally
heard in the better ear. It is more likely to be a sensorineural hearing loss.
test. The vibrating fork is placed in the middle of the forehead and the
patient is asked whether any sound is heard, and if so, whether it is equally
heard in the better ear. It is more likely to be a sensorineural hearing loss.
Rinne’s
Test
Test
Strike a tuning fork and hold it vertically with
its nearest prong about 1cm away from the patient’s external L meatus. The
patient is asked to repeat on which of the two positions was it louder.
Normally, the patient should hear the air conduction better than the bone
conduction (i.e. first position better than the second). This is a positive
Rinne’s test. If the Rinnes’s test is positive and there is hearing impairment,
it is a sensorineural and not a conductive problem. If there is a negative
Rinne’s test with hearing loss, then the problem is conductive one.
its nearest prong about 1cm away from the patient’s external L meatus. The
patient is asked to repeat on which of the two positions was it louder.
Normally, the patient should hear the air conduction better than the bone
conduction (i.e. first position better than the second). This is a positive
Rinne’s test. If the Rinnes’s test is positive and there is hearing impairment,
it is a sensorineural and not a conductive problem. If there is a negative
Rinne’s test with hearing loss, then the problem is conductive one.