Clinical skills 1 - Ear Examination

Question 1

In an ear examination, what three thigs are carried out?

Answer 1

Otoscopy A Rinnie’s test A Weber’s Test

Question 2

When taking a history from the patient who has a problem with their ear, what are important questions to ask?

Answer 2

Any hearing loss or tinnitus Any vertigo Any discharge or pain Previous ear surgery Any significant past noise exposure Any family history of early onset hearing loss

Question 3

After questions, first thing to do is selct the correctly sized aural speculum (bit on end of otoscope) Which ear do you examine first?

Answer 3

Always examine the better ear first if there is a problem in one of them

Question 4

What do you look for first of all with the otoscope?

Answer 4

Look for scars infront or behind the ear (endaural (runs into the ear canal maybe) or postaural incisions)

Question 5

Then what position is the ear moved into to carry out examination?

Answer 5

Retract the pinna postosuperiorly and clear view of the eardrum should be obtained

Question 6

When carrying out otoscopy, both ears should be examined, how are the ears examined? (as in which hand is the otoscope in)

Answer 6

When examining right ear otoscope is in the right hand when examining left ear it is in the left hand

Question 7

What should you commment on when looking at the tympanic membrane using the otoscope?

Answer 7

Comment on colour of the membrane, whether the cone of light is visible If the tymapnic membrane is intact and whether there is any visible fluid behind the tympanic membrane

Question 8

What should you remember to do with the ear piece before and after?

Answer 8

remember to wipe the ear piece with an alcohol wipe

Question 9

What can be used instead of an auroscope to look inside somebodies ear? It allows for pictures of the ear to be taken

Answer 9

Use a rigid endoscope

Question 10

What is being pointed to?

Answer 10

Pointing to the umbo - most depressed part of tympanic membrane

Question 11

What is being pointed to?

Answer 11

The handle of the malleus - can see the cone of light also on the tympanic membrane

Question 12

What are the two tuning fork tests that are also carried out and at what frequency?

Answer 12

Rinnie’s and Weber’s test Carried out at 512Hz

Question 13

Rinnies test involves putting the ringing tuning fork in front of the ear then the base on the mastoid process of the temporal bone What is a positive and what is a negative rinnie’s test?

Answer 13

Positive rinnies test is when sound is heard loud better with the tuning fork in front of the ear Negative is when sound is heard better with the tuning fork on the mastoid process Positive is normal - better hearing on air rather than bone conduction

Question 14

In the Weber’s test we put the ringing tuning fork in the midline of the foreheard and see which ear the patient can hear it louder in or whether it is heard in the midline Where do normal patinets hear the sound? What about abnormal?

Answer 14

Normal patients hear the sound in the midline Abnormal means the sound will be localised to one side

Question 15

If there is a conductive hearing loss in the right ear What will rinnies and webers test show?

Answer 15

Unilateral right ear conductive hearing loss * Rinnie’s test - Rinnies negative in the right ear (BC > AC) * Weber’s - Sound would localise to the affected ear so the right ear

Question 16

Why is Weber’s heard better in the affected ear in a conductive hearing loss?

Answer 16

This is because the conduction problem in this ear masks out the external air conduction noise meaning the sound that is heard is only the bone conduction

Question 17

In a patient with a unilateral sensorineural hearing loss (ie for the right ear), what is heard on rinne’s and weber’s test?

Answer 17

Rinne’s test is positive for both ears - no conductive loss in either Weber’s - the sound is localise to the unaffected (left in this case) ear meaning the right ear is experiencing a sensorineural hearing loss

Question 18

patient experiecnes bilateral high frequency hearing loss with age What is this?

Answer 18

Usually presbycusis

Question 19

How does presbycusis show on rinne and weber?

Answer 19

Rinnie - positive rinne for both ears Weber - normal weber for both ears (since it is bilateral it does not lateralize)

Question 20

Patient has a negative rinne on the left ear with sound heard better in the right ear on weber’s, what is this?

Answer 20

this is a combined hearing loss in the left ear

Question 21

Patient has a negative rinne right ear with sound localised to the right ear weber What is this?

Answer 21

Unilateral right ear conductive hearing loss

Question 22

Patient has a positive rinne for both ears with sound localised to the left ear in weber What is this?

Answer 22

This is a unilateral sensorineural hearing loss int he right ear

Question 23

What test can be carried out after the Weber and Rinnie to detect whether it is a conductive, sensorineural or mixed hearing loss? Wont be asked to carry this out

Answer 23

Carry out pure tone audiometry (PTA)