🦻 Flashcards
What do you assess in direct light inspection of the ears ?
Alignment, symmetry of position of ears
Skin, color, swelling
Presence of secretion, cerumen, swelling
What do you assess in otoscope inspection ?
Skin : color, swelling, discharge
Foreign bodies
Eardrum (color, alignment), Pollitzer luminous cone, pars flaccida, malleus, incus
Presence of air bubbles, serous fluid pus, blood, sclerosis, perforated eardrum
What do you palpate in the ear ?
Swellings in : auricle, temporal bone, auricle back groove
Palpate mastoid always
Palpate auricle on indication
Technique of otoscope :
Check light and place clean specula. Start with unaffected ear.
Pull auricle slightly upward and backward to stretch auditory canal. Pull auricle flat against skin.
Insert otoscope with same hand as the ear side.
Place finger against head for support
Technique of whispered voice test :
Sit behind patient. Whisper 6 combination of number and letter in each ear
Technique of Rinne’s test :
Strike tuning fork (512). Place stem against mastoid and ask patient when they cannot hear it anymore.
Then place tuning fork 2 cm front of ear with parallel prong.
Result of Rinne’s test
Positive test = normal = best in air conduction
Negative test => conductive hearing loss
Technique of Weber’s test :
Strike tuning fork, place it at the center of patient forehead. Ask where they perceive the sound.
Sound only on one side => pathological
No sound => repeat on bridge of nose then upper teeth
Result of Weber’s test
Conductive hearing loss : on the side that hear
- physical advantage hearing by bone conduction because air conduction is filtered out.
Sensorineural hearing loss : sound heard on healthy ear, the sick ear does not ear
Technique of Tilt test - Positioning test - Dix Hallpike manoeuvre
Patient sit on examination table, leg stretched. When they lie back their head project beyond the table.
Hold head rotate it 45° to one side. Lower patient in supine position with head hanging.
Patient keep eye open focusing on the tip of your nose.
Return patient to starting position in smooth movement. Repeat on the other side.
What do you assess in the Tilt test ?
Check for nystagmus or vertigo.
Left : assess left posterior and right anterior semicircular canals
Right : assess right posterior and left anterior semicircular canal
Technique of the head impulse test HIT
Sit opposite to patient. Ask them to look at the tip of your nose. Hold patient head then rotate it 20° to the left/right then abruptly back to center.
Or do opposite.
Result of the HIT
Test vestibular ocular reflex.
Positive test : eyes follow the turn then re fixate => peripheral cause.
Abnormal ear shape ?
Abnormal alignment => disorder of mastoid / parotid gland
Cauliflower ears => trauma
Helix can develop hard nodules
Otitis externa symptoms ?
Auricle tender to touch, red, moist, swollen auditory canal
Otitis media symptoms ?
Red tympanic membrane : acute
- especially when eardrum bulging or disappearance of luminous cone
Retracted eardrum, white-yellowish : with effusion
- bubbles of air/fluid
Perforation of tympanic membrane : with discharge
Peripheral nystagmus ?
Unidirectional, never purely vertical or torsional.
Visual fixation inhibit it.
Tinnitus and deafness often present.
Central nystagmus ?
Bidirectional or unidirectional, can be purely horizontal, vertical or torsional.
Is not inhibited by visual fixation.
Associated with diplopia, hiccups, dysarthria
Type of hearing loss ?
Sensorineural : understanding speech, noisy environment make it worse
CNN : Conductive hearing loss Needs Noisy environment
Symptoms and pathology associated with earache and discharge
Fever, cough, sore throat, concurrent upper respiratory infection
- otitis externa / media depending on location of pain
Yellow-green discharge : acute otitis externa or acute / chronic otitis media with perforation
What is tinnitus ?
Perceived sound that has no external stimuli. Common and increase with age.
Meniere disease : tinnitus, hearing loss, vertigo
Type of dizziness ?
Vertigo : room spinning, tilting
Sense of passing out : presyncope
Sense of unsteadiness : disequilibrium
What is vertigo and causes ?
Sensation of true rotational movement of patient and surrounding
Peripheral cause : BPPV, labyrinthitis, vestibular neuritis, Meniere disease
Central cause : (ataxie, diplopia, dysarthria) cerebral vascular disease, posterior fossa tumors, vestibular migraine
SO STONED : questions of ear
Symptoms : vertigo, dizziness, instability, oscillopsia, headache
Occurrence : how often ?
Since : when did it start ?
Triggers : Head movement, stress
Otological : hearing loss, tinnitus
Neurological : loss of consciousness, paralysis, epilepsy
Evolution : of complaints
Duration : of episodes
How do you know which ear it is based on the eardrum ?
Look at the cone of light.
In the right ear the cone of light is at 4-5 o’clock => right side of eardrum
In the left ear the cone of light is at 7-8 o’clock => left side of eardrum
