Ear History and Exam

Question 1

What questions should you ask about the presenting complaint (dizziness)?

Answer 1

1. Room spinning? Going to faint? Unsteady on your feet?
2. Slowly or suddenly?
3. Ringing in your ears?
4. Deafness? Unwell? Pain? Sickness?
5. All the time or comes and goes? What are you doing when it starts?
6. Anything bring it on? Better/worse? Head turning?

Question 2

What questions should you ask as part of a neurological screen (dizziness)?

Answer 2

1. Numbness/tingling?
2. Changes in vision/eye pain?
3. Weakness? Difficulty with ADLs?
4. Trouble with speech?
5. Headaches?
6. Seizures? Blackouts?
7. Weight loss? Appetite?

Question 3

What should you ask about in past medical history (dizziness)?

Answer 3

Strokes, recent infections, recent trauma

Question 4

What should you ask about in medication history (dizziness and hearing loss)?

Answer 4

1. Allergies

2. Any recent - gentamicin, vancomycin, vincristine, chloroquine

Question 5

What should you ask about in social history (dizziness and hearing loss)?

Answer 5

Occupation, smoking, drugs, alcohol, loud music

Question 6

What are the differentials for vertigo?

Answer 6

1. BPPV
2. Acute labyrinthitis
3. Meniere’s disease
4. Acoustic neuroma
5. Ototoxicity
6. Ramsay Hunt syndrome
7. Trauma

Question 7

What questions should you ask about the presenting complaint (hearing loss)?

Answer 7

1. Which ear did it start in? One better than the other?
2. Slowly or suddenly? What were you doing when it came on?
3. Any particular noise difficult to hear?
4. Ringing in your ear?
5. Always been hard of hearing? Any change?
6. Better or worse? Background noise affect?

Question 8

What associated features should you ask about (hearing loss)?

Answer 8

1. Room spinning? Balance issues?
2. Discharge? Cotton bud cleaning?
3. Numbness or tingling anywhere? Weakness?
4. Ill/feverish recently?
5. Weight loss/appetite?

Question 9

What should you ask about in family history (hearing loss)?

Answer 9

Problems with hearing/tinnitus/vertigo?

Question 10

What are the differentials for hearing loss?

Answer 10

1. External canal pathology - wax, foreign body
2. Tympanic membrane perforation
3. Otitis media with effusion
4. Otosclerosis
5. Cholesteatoma
6. Nasopharyngeal tumour
7. Presbycusis
8. Meniere’s disease

Question 11

What do you inspect in the oral cavity and throat?

Answer 11

Lips, tongue, buccal mucosa, gums, uvula, floor of mouth, soft and hard palates, tonsils.

Question 12

What investigative procedures can you perform in the nose?

Answer 12

Anterior rhinoscopy +/- rigid nasal endoscopy

Question 13

What do you inspect in the ears?

Answer 13

Pinna, external auditory canal, tympanic membrane (otoscope)

Question 14

What is Rinne’s test?

Answer 14

512Hz tuning fork placed on mastoid process and in front of ear.

Question 15

What is Rinne’s test positive and what does it indicate?

Answer 15

1. Air conduction louder than bone conduction

2. Normal or mild/moderate sensorineural hearing loss on that side

Question 16

What is Rinne’s test negative and what does it indicate?

Answer 16

1. Bone conduction louder than air conduction.

2. Conductive or severe sensorineural hearing loss on that side.

Question 17

What is Weber’s test?

Answer 17

512Hz tuning fork placed on forehead.

Question 18

What does Weber’s test not lateralising indicate?

Answer 18

Normal or symmetrical hearing loss.

Question 19

What does Weber’s test lateralising indicate?

Answer 19

Ipsilateral conductive hearing loss or contralateral sensorineural hearing loss.

Question 20

How is the larynx investigated?

Answer 20

Wooden stick + light +/- laryngoscopy

Question 21

What should be examined in the neck?

Answer 21

Palpation of cervical lymph nodes and thyroid gland.