Otoscopy Flashcards
What do you do in the introduction of an ear examination
Wash hands, Introduce self, Patients name & DOB & what they like to be called, Explain examination and get consent
Explain procedure and that they must stay completely still when you use the otoscope
Position patient – seat at same level as you with access to both ears
Note and remove any hearing aids
Get otoscope, speculum, 512Hz tuning fork
how do you inspect the ear
o Skin in front and behind ear: skin tags, erythema, scars, preauricular sinuses/pits o Pinna: any skin changes (e.g. neoplasia), deformities (e.g. accessory auricle), scars, erythema (erysipelas, chondritis), perichondrial haematoma (trauma) o External auditory meatus: erythema, pus/discharge (otitis externa) o Mastoid: erythema/swelling (mastoiditis)
How do you palpatate the ear
Tug pinna gently (tenderness = mastoiditis)
Palpate mastoid (tenderness = mastoiditis)
Feel for pre/post-auricular lymph nodes (infections)
What are you looking for I the auditory canal
- Wax
- foreign bodies
- skin quality
- thick white growth = cholesteatoma
- erythema/discharge - otits externa
What are you looking for in the tympanic membrane
Colour – should be pinkish-grey (red = infection; scarred = typanosclerosis)
Structure – look for perforation, tympanostomy (grommet), bulging (infection) or retraction (Eustachian tube
dysfunction)
Fluid (effusion, haemotympanum)
What is a rough hearing test
ask patient to occlude one of their ears and gently rub your index finger and thumb together. Move your hand from peripherally towards their ear and ask them to tell you when they hear it. Repeat on other side.
What is Weber’s test
Use a 512Hz tuning fork. Twang the long ends and place the round base of the fork on the patient’s forehead between their eyes. Ask them if one side is louder than the other (if one side is louder, either that side has a conductive deficit, or the contralateral side has a sensorioneural deficit - Rinnie’s test can then confirm which).
What is Rhines test
use a 512Hz tuning fork. Twang the long ends and place the round base of the fork on the patient’s mastoid process. Ask them to tell you when the sound stops. Then, place the long ends near the patient’s ear. Ask them if they can then hear it again – air conduction should be louder than bone conduction (if they cannot hear it again, there is a conductive deficit in that ear).
What is otitis external
inflamed swollen narrow canal with
discharge/flaking skin. Treated with Abx-steroid eardrops (if acute) or anti-
fungal-steroid eardrops (if chronic).
What is acute otitis media
swollen red tympanic membrane. May be effusion or perforation. Treated with oral Abx e.g. amoxicillin.
What is otitis media with effusion
- (Glue ear) – fluid level behind tympanic
membrane due to Eustachian tube dysfunction without inflammation or infection - Observed for at least 3
months as many resolve, but may require tympanostomy.
What is cholesteatoma
slowly expanding growth of keratinised squamous epithelium that
can extend into surrounding tissues. Treated by excision
What are the landmark features that make up the tympanic membrane
- The Pars tense with its light reflex
- the umbo at the centre of the membrane
- the handle and lateral process of the malleus
You should use a different..
Speculum for each ear to reduce risk of infection transfer
What does pneumatic otoscopy test for
Pneumatic otoscopy helps determine the mobility of the TM
- a normal TM will respond by concaving into the middle ear cavity
