3 - ENT - Otology - Ear testing and otoscopy - Testing hearing

Question 1

How to do Rinne’s test

Answer 1

compare air conduction next to ears, with bone conduction (mastoid)

Question 2

Rinne negative

Answer 2

bone conduction > air conduction - conductive deafness

bone louder than air

Question 3

Rinne positive

Answer 3

air conduction > bone conduction - sensorineural deafness OR normal hearing
(air louder than bone)

Question 4

how to do weber test

Answer 4

tuning fork on forehead/teeth/bone in midline - which side is louder or are they equal?

Question 5

weber - conductive deafness?

Answer 5

sound better on affected side

Question 6

weber - sensorineural deafness

Answer 6

sound better on other side

Question 7

How to do pure tone audiogram

Answer 7

tone played through headphones and bone transducer, pt indicates when they can hear the tone

Question 8

what is the normal dB range

Answer 8

0-20dB

Question 9

what dB is characteristic of profound hearing loss

Answer 9

> 90 dB

Question 10

What are the dB ranges for the different hearing losses

Answer 10

20-40 = mild loss
40-55 = mod loss
55-70 = mod severe loss
70-90 = severe loss

Question 11

what deafness is indicative of a clear gap between air and bone conduction, in pure tone audiometry

Answer 11

a conductive hearing loss

Question 12

typical PTA for noise induced deafness

Answer 12

typical drop at 4-6kHz, increasing again at 8kHz

Question 13

typical PTA for presbyacusis

Answer 13

drop at upper frequency end in both bone and air conduction

Question 14

what is cahart’s notch and what does it indicate

Answer 14

drop in BC at ~2kHz - due to otosclerosis, ossicular dysfunction

Question 15

what is cookie bite loss - usual cause?

Answer 15

bite size chunk in middle of range - usually hereditary

Question 16

Tympanometry - three types of graph and what they look like

Answer 16

type a - bell shaped
type b - flattened (high/low)
type c - peak shifted to left

Question 17

Type A tympanogram - is this normal? what if shallow? what if deep?

Answer 17

normal

shallow - suggests less compliance - Hx of middle ear problems

deep - suggests increased compliance, Hx of perforations, grommets, or ossicular chain disruption

Question 18

Type B tympanogram - is this normal? low vs high?

Answer 18

not normal
low - increased middle ear pressure eg OM
high - perforation (increased ear canal volume)

Question 19

Type C tympanogram - is this normal? why?

Answer 19

not normal

negative middle ear pressure - eg eustachian tube dysfunction. sinus congestion