EARS

Question 1

How to straighten the ear canal of ADULT?

Answer 1

Pull pinna UP and back

Question 2

How to straighten the ear canal of children?

Answer 2

Pull pinna DOWN and BACK

Question 3

It is an important diagnostic tool for examining the ear canal and tympanic membrane (eardrum). It is an integral part of all pediatric examinations. It is usually only performed in adults if they have mentioned ear discomfort.

Answer 3

Otoscopy

Question 4

Procedure for Otoscopy:

Answer 4

1. Prepare the Otoscope:

• Select the largest speculum that comfortably fits the patient’s ear and attach it to the head of the otoscope.
• Turn on the light source of the otoscope.

2. Position the Otoscope Handle:

• Hold the otoscope with your dominant hand.
• Angle the otoscope handle downward or towards the patient’s forehead to facilitate a better view of the ear canal.

3. Stabilize Your Hand:

• Stabilize your otoscope hand by resting the fourth and fifth fingers on the patient’s head to maintain control and prevent accidental injury.

4. Position the Patient’s Ear:

• With your free hand, pull the ear up and back (for adults) or down and back (for infants and children) to straighten the ear canal.
• This positioning helps straighten the ear canal, providing a clearer view of the tympanic membrane.

5. Insert the Otoscope:

• Gently insert the otoscope into the ear canal at a slightly downward angle to avoid damaging the ear.
• Be cautious and avoid applying too much pressure.

6. Examine the Ear Canal and Tympanic Membrane:

• While looking through the otoscope, examine the ear canal for any abnormalities such as redness, swelling, or discharge.
• Evaluate the tympanic membrane for signs of infection, perforation, fluid, or any other irregularities.

Question 5

Purpose: Evaluates hearing acuity by checking the ability to perceive whispered speech.

Procedure:

• Stand behind the patient (about 60 cm or 2 feet away) to prevent lip reading.
• Occlude the non-tested ear by gently rubbing the tragus.
• Whisper three random words or numbers into the unoccluded ear.
• Ask the patient to repeat what they heard.
• Repeat the process for the other ear.

Interpretation:

• Normal: The patient correctly repeats most of the whispered words.
• Abnormal: Difficulty in hearing may indicate hearing loss in that ear.

Answer 5

Whispered Voice Test

Question 6

Purpose: Assesses high-frequency hearing.

Procedure:

• Hold your fingers about 3-4 inches (several cm) away from each ear.
• Rub your fingertips together softly.
• Ask the patient if they can hear the sound.
• Compare the hearing perception in both ears.

Interpretation:

• Normal: The patient hears the rubbing sound equally in both ears.
• Abnormal: If one ear detects the sound less or not at all, it may indicate unilateral hearing loss.

Answer 6

Finger Rub Test

Question 7

Purpose: To determine if there is any lateralization of sound (hearing sound louder in one ear compared to the other), which helps differentiate between conductive and sensorineural hearing loss.

Procedure:

1. Vibrate a tuning fork by striking it against a hard surface.
2. Place the base of the vibrating tuning fork on the midline of the patient’s forehead (or the top of their head if preferred).
3. Ask the patient from which ear the sound is louder (or if it is heard equally in both ears).

Interpretation:

Normal (no lateralization): The sound should be heard equally in both ears. This suggests normal hearing or sensorineural hearing loss in both ears.

Lateralization to one ear:

• Conductive hearing loss: If the sound is heard louder in the affected ear, this suggests conductive hearing loss in that ear (e.g., due to fluid in the ear, earwax, or a middle ear issue).
• Sensorineural hearing loss: If the sound is heard louder in the unaffected ear, this suggests sensorineural hearing loss in the ear where the sound is quieter (indicating damage to the inner ear or auditory nerve on that side).

Answer 7

Weber Test

Question 8

It is used to compare air conduction (AC) and bone conduction (BC) of sound, helping to identify the type of hearing loss (conductive or sensorineural).

Answer 8

Rinne Test

Question 9

Procedure for Rinne Test:

Answer 9

1. Prepare the Tuning Fork:

• Strike a vibrating tuning fork to get it ringing.

2. Bone Conduction Test:

• Place the base of the vibrating tuning fork on the mastoid process (the bony prominence behind the ear).
• Ask the patient to indicate when the sound is no longer heard.

3. Air Conduction Test:

• Once the patient can no longer hear the sound from the tuning fork on the mastoid, immediately move the “U” part of the fork (the open ends) close to the outer ear.
• Ask the patient if they can still hear the sound.

4. Interpretation:

• Normal (Positive Rinne): Air conduction (AC) is better than bone conduction (BC), meaning the patient should hear the tuning fork next to the ear after they no longer hear it on the mastoid process.

This suggests normal hearing or sensorineural hearing loss.

• Abnormal (Negative Rinne): If the patient does not hear the tuning fork next to the ear after it is no longer audible on the mastoid process, this indicates that bone conduction is better than air conduction (BC > AC).

This suggests conductive hearing loss in the ear being tested.