Otology history and examination

Question 1

List three points of inspection for ear exam

Answer 1

pinna
scars
congegnital abnormalities
external auditory meatus discharge
appliances- hearing aids, implants, prostheses

Question 2

What are the components of ear exam

Answer 2

inspection
otoscopy
clinical hearing test- free field speech
facial nerve function
eye movements and nystagmus

Question 3

Why should you check facial nerve function in hearing test

Answer 3

cranial nerve runs in ear

Question 4

Further investigations to consider following clinical ear exam?

Answer 4

pure tone audiometry +/ tympanometry
CT/MRI
examination under anaesthetic

Question 5

What are otlology specific questions in history to elucidate

Answer 5

1. Hearing loss – onset, severity/fluctuation, symmetry, noise exposure, FH
2. Tinnitus (perception of noise in ears) – symmetry, pulsatile vs non-pulsatile
3. Discharge (otorrhoea) – serous / purulent, duration
4. Vertigo – (illusion of movement) NOT lightheadedness, duration, frequency
5. Previous ear surgery

Question 6

You see attic erosion and a retracted tympanic membrane on otoscopy. What is the likely diagnosis?

Answer 6

cholesteatoma

Question 7

3 year old crying child pulling at ear. Otoscopy shows protruded/bulging tympanic membrane. What is the diagnosis?

Answer 7

acute otitis media

Question 8

What should you assess in ear exam?

Answer 8

Four F’s
facial nerve
free field (whispering and covering ear)
fork
fistula

Question 9

What is the fistula test for?

Answer 9

vertigo assessment
apply pressure to tragus and look for nystagmus
=tear of defect in the membranes that separate the middle ear from the perilymphatic space in the inner ear.