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Yr 3 - Clinical Examinations > Hearing Assessment & Otoscopy > Flashcards

Hearing Assessment & Otoscopy Flashcards

1
Q

Give the overall steps of a hearing assessment & otoscopy station

A
  1. General inspection
  2. Gross hearing assessment
  3. Weber’s test
  4. Rinne’s test
  5. External ear - inspection, palpation
  6. Otoscopy
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2
Q

Describe how the gross hearing assessment is carried out

A
  1. Ask the patient if they have noticed any change in their hearing recently.
  2. Explain that you are going to say 3 words or numbers and you’d like them to repeat them back to you (choose two-syllable words or bi-digit numbers).
  3. Stand behind patient (approx. 60cm from patients’ ear) and mask the ear not being tested by rubbing the tragus
  4. Whisper a number or word and ask patient to repeat back to you
  5. Repeat this on same ear with another two different numbers
  6. Repeat on other ear
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3
Q

if the patient gets two thirds or more correct in the gross hearing assessment, what is their hearing level?

A

their hearing level is 12db or better

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4
Q

If there is no response in the gross hearing assessment, what can you do?

A

move closer and repeat test at 15cm

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5
Q

What type of tuning fork is used in a hearing assessment?

A

512 Hz

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6
Q

Describe how Weber’s test is carried out

A

Tap a 512Hz tuning fork (on knee NOT table) and place in the midline of their forehead

Ask them which ear it is heard loudest in

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7
Q

Describe results of Weber’s test in normal hearing

A

sound heard equally in both ears (i.e. middle)

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8
Q

Describe results of Weber’s test in sensorineural deafness

A

Sound heard loudest on side of intact ear

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9
Q

Describe results of Weber’s test in conductive deafness

A

sound is heard louder on the side of the affected ear

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10
Q

Describe results of Rinne’s test in normal hearing

A

air conduction > bone conduction (Rinne’s test positive)

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11
Q

Describe results of Rinne’s test in sensorineural deafness

A

air conduction > bone conduction (Rinne’s test positive)

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12
Q

Describe results of Rinne’s test in conductive deafness

A

bone conduction > air conduction (Rinne’s negative)

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13
Q

What occurs in conductive hearing loss?

A

Occurs when sound is unable to effectively transfer at any point between the outer ear, external auditory canal, tympanic membrane, and middle ear (ossicles)

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14
Q

What type of hearing loss does excessive ear wax cause?

A

Conductive

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15
Q

What type of hearing loss does otitis externa cause?

A

Conductive

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16
Q

What type of hearing loss does otitis media cause?

A

Conductive

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17
Q

What type of hearing loss does otosclerosis cause?

A

Conductive

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18
Q

What type of hearing loss does a perforated tympanic membrane cause?

A

Conductive

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19
Q

What happens in sensorineural hearing loss?

A

Occurs due to dysfunction of the cochlea and/or vestibulocochlear nerve

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20
Q

What type of hearing loss does presbycusis cause?

A

Sensorineural

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21
Q

What type of hearing loss does excessive noise exposure cause?

A

Sensorineural

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22
Q

What type of hearing loss do viral infections (e.g. CMV) cause?

A

Sensorineural

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23
Q

What type of hearing loss do ototoxic medications (e.g. gentamicin) cause?

A

Sensorineural

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24
Q

What aspects of the external ear should you inspect?

A
  1. Pinnae
  2. Mastoid
  3. Pre-auricular region (in front of ear)
  4. Conchal bowl
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25
Q

What are you inspecting the pinnae for?

A
  • Asymmetry
  • Deformity
  • Ear piercings
  • Erythema & oedema
  • Scars
  • Skin lesions e.g. actinic keratoses, BCC, SCC
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26
Q

What condition is erythema & oedema typically associated with?

A

otitis externa

27
Q

What deformities of the pinna are you inspecting for?

A

Acquired (e.g. cauliflower ear) or congenital (e.g. anotia, microtia, low-set ears)

28
Q

What are you inspecting the mastoid for?

A
  • Erythema & swelling – mastoiditis
  • Scars – previous surgery e.g. mastoidectomy
29
Q

What are you inspecting the pre-auricular region for?

A
  • Pre-auricular sinus/pit
  • Lymphadenopathy
30
Q

What is a pre-auricular sinus/pit?

A

a common congenital deformity that appears as a dimple in the pre-auricular region which can sometimes get infected and require surgical drainage

31
Q

What can lymphadenopathy of the pre-auricular region indicate?

A

Ear infection e.g. otitis media, otitis externa

32
Q

Areas of ear:

A
33
Q

What are you inspecting the concha bowl for?

A

Inspect for signs of active infection e.g. erythema and purulent discharge

34
Q

What areas of the external ear are you palpating?

A
  1. Tragus
  2. Regional lymph nodes - pre-auricular & post-auricular
35
Q

What are you palpate the tragus for?

A

Palpate the tragus for tenderness which is typically associated with otitis externa.

36
Q

What is cauliflower ear?

A

An irreversible condition that develops as a result of repeated blunt ear trauma.

37
Q

What is anotia?

A

complete absence of the pinna

38
Q

What is microtia?

A

underdevelopment of the pinna

39
Q

What conditions are low set ears commonly seen in?

A

feature of genetic syndromes e.g. Down’s syndrome, Turner’s syndrome

40
Q

Which ear should you examine first in otoscopy?

A
  • Check if patient has any ear discomfort and if so, examine the non-painful side first
  • Ask the patient which is their ‘better’ ear and examine this one first (can be useful for comparison)
41
Q

Describe how to insert the otoscope

A
  1. Ensure light is working and apply a sterile speculum (the largest that will fit comfortably into ear)
  2. Pull pinna upwards and backwards with your other hand to straighten external auditory canal
  3. Position otoscope at external auditory meatus
  4. Advance otoscope under direct vision – be gentle and slow
42
Q

Why do you pull the pinna upwards and backwards in otoscopy?

A

To straighten external auditory canal

43
Q

What hand should you hold the otoscope in?

A

Otoscope should be held in right hand for patients’ right ear (and vice versa)

44
Q

How should you hold the otoscope?

A

Hold otoscope like a pencil and rest your hand against patients’ cheek for stability – prevents damage to ear if sudden movement

45
Q

After inserting the otoscope, what should you inspect the external auditory canal for?

A
  1. Excessive ear wax
  2. Erythema & oedema – e.g. otitis media
  3. Discharge – otitis externa or otitis media with associated tympanic membrane perforation
  4. Foreign bodies – cotton buds, insects etc
46
Q

What is the most common cause of conductive hearing loss?

A

Excessive ear wax

47
Q

How should you assess the tympanic membrane?

A

Systematically inspect the 4 quadrants of the TM

48
Q

What are you inspecting the tympanic membrane for?

A
  • Colour
  • Shape
  • Light reflex
  • Perforation
  • Scarring
  • Grommets (children)
49
Q

What is the colour of a healthy tympanic membrane?

A

pearly grey & translucent

50
Q

What is the shape of a healthy tympanic membrane?

A

relatively flat

51
Q

What would a bulging TM indicate?

A

increased middle ear pressure (commonly caused by acute otitis media with effusion – often an associated visible fluid level)

52
Q

What would retraction of the TM indicate?

A

reduced middle ear pressure (commonly caused by pharyngotympanic tube dysfunction 2ary to URTIs and allergies)

53
Q

What is reduced middle ear pressure commonly caused by?

A

pharyngotympanic tube dysfunction 2ary to URTIs and allergies

54
Q

What is the light reflex of the TM?

A

The cone of light, or light reflex, is a visible phenomenon which occurs upon examination of the tympanic membrane with an otoscope. Shining light on the tympanic membrane causes a cone-shaped reflection of light to appear in the anterior inferior quadrant.

55
Q

In healthy individuals, where should the cone of light appear?

A

Cone-shaped reflection of light should appear in the anterior inferior quadrant

56
Q

What condition is absence or distortion of the light reflex associated with?

A

Absence or distortion of light reflex is associate with otitis media (due to bulging of TM

57
Q

Give some causes of a perforated TM

A
  • Infection (e.g. OM with effusion)
  • Trauma (e.g. diving related)
  • Cholesteatoma
  • Insertion of grommets
58
Q

Which aspect of the TM does a cholesteatoma typically cause a perforation?

A

superior aspect

59
Q

What condition causes scarring of the TM?

A

Tympanosclerosis

60
Q

What type of hearing loss can tympanosclerosis cause if extensive?

A

Conductive

61
Q

What does scarring of the TM typically develop 2ary to?

A

2ary to otitis media or after insertion of grommets

62
Q

Where should you discard the otoscope speculum?

A

into a clinical waste bin

63
Q

Give some further investigations following a hearing assessment/otoscopy

A
  • Cranial nerve exam – identify evidence of facial nerve pathology
  • Audiometry & tympanometry – screen for hearing loss
  • Swab discharge if present

Yr 3 - Clinical Examinations (11 decks)

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