Ear Disease

Question 1

Basic method of examining hearing?

Answer 1

Tuning fork test

Question 2

Describe Rinne’s test

Answer 2

Strike the tuning fork and place on the mastoid bone on one side

Once the patient can hear this, place the prongs of the tuning fork 1 cm away from the external auditory canal

Ask if the noise is louder when placed against the bone or when held up next to the ear

Question 3

Describe Weber’s test

Answer 3

Strike tuning fork lightly on your elbow or knee and place the base firmly on the forehead OR any bone prominence in the midline of the skull (equidistant from both ears)

Normal result - patient can hear the tuning fork tone in both ears equally

Abnormal result - patient can hear the tuning fork tone in one ear more than the other

Question 4

Ix for checking hearing?

Answer 4

Pure tone audiogram (PTA) - produces sounds at different frequencies; 0 is normal

Tympanogram - checking movement of the eardrum in response to sounds:
• Flat line - indicates middle ear pathology (something behind the eardrum), e.g: fluid
• Normal is the Ad line

Question 5

What should be done to an adult’s ear before examination?

Answer 5

Pull it upwards and backwards (affords a clear view)

Question 6

Other diagnostic Ix?

Answer 6

Otoendoscopy - endoscopy into the mid-meatus:
• Colour
• Handle of malleus
• Eardrum is concave, not flat, so a reflection of light should be seen

Question 7

What is the D principle of ear disorder symptoms?

Answer 7

1. Deafness
2. Discomfort (pain)
3. Discharge
4. Dizziness
5. Din Din (tinnitus - the sound of silence)
6. Defective movement of the face (CN VII pathway is through the ear)

Question 8

Types of deafness?

Answer 8

Conductive - problem conducting sound waves anywhere along the route through the outer ear, tympanic membrane or middle ear

Sensorineural - cause lies in the cochlea (organ of hearing) or in a nerve; the 2 are different but they come together on an audiogram

Mixed - of more than 1 type of hearing loss

Central - issue with the higher brain centres, e.g: stroke

Question 9

Nerves potentially inv. with earache?

Answer 9

All the nerves supplying the ear:
• CN V
• CN VII
• CN IX
• CN X
• C2 and C3

Question 10

Most common causes of earache, esp. if the examination is normal?

Answer 10

Sore throat

Toothache

Question 11

Pathological causes of discharge?

Answer 11

AKA otorrhoea

• Acute otitis media (AOM)
• Chronic otitis media (COM)
• CSF

Question 12

Potential causes of CSF leakage?

Answer 12

Congenital malformation (lack of fusion of the walls of the ear)

Head injury causing a temporal bone fracture

Question 13

Typical defective facial movement occurring with ear disorders?

Answer 13

Facial palsy due to lower motor neuron disorder (UMN lesions classically spares the forehead)