Hearing Assessment

Question 1

Introduction

Answer 1

Hello, I’m An Nakamura a 3rd year medical student. Can I confirm your name and DOB?
I’ve been asked to examine your ears
I’ll use this piece of equipment called an otoscope to examine your ears and a tuning fork to assess your hearing. Will this be ok? Do you have any questions? Are you in any pain today?

Question 2

Inspections

Answer 2

Hearing aids => ask patient to remove them for otoscopy

Mobility aids => vestibular cochlear issue affecting hearing and balance

Question 3

Gross hearing assessment

• explanation
• adjustments

Answer 3

Have you recently noticed changes in your hearing?
I’m going to rustle my fingers by one of your ears and whisper 2 numbers. I’d like you to tell me what 2 numbers you hear.

Ok, now I will do the same in the other ear

I’ll try again but louder
I’ll try again but closer to your ear

Question 4

Rinne and Weber’s test

-explanation

Answer 4

I will now use a tuning fork to assess you hearing in more detail. I will let the tuning fork ring and place it against the back of your ear, please tell me when you hear the sound and when you no longer hear it.
Do you hear the sound now?

I will now let the tuning fork ring and place it on your forehead. Does the tuning fork sound the same on both sides or louder on one side?

Question 5

Ear inspection

-explanation

Answer 5

I’m now going to have a look at your ear

I will feel your ear (tragus, lymph nodes)

Question 6

Otoscopy

-explanation

Answer 6

Do you have any pain in your ears? I’ll examine the other ear first
I’m going to gently pull on your outer ear so I can get a better view of your ear canal. I will slowly move the otoscope into your ear under direct visualisation

I’m now going to look at your other ear

Question 7

Further examinations

Answer 7

Cranial nerve examination => facial nerve pathology

Audiometry, tympanometry => screen for hearing loss