Otoscopy & Case Hx Flashcards
More errors are made because of inadequate history-taking and superficial exam than any other cause.
true
waht is humanistic care
focused and centered on the patient and family and not based primarily on the preconceptions and protocols of the healthcare provider.
first impressions dont really matter
false
they will last
what is case history
defined as a planned professional conversation that enables the patient to communicate his/her symptoms, feelings and fears to the clinician so as to obtain an insight into the nature of patient’s illness & his/her attitude towards them.
more errors are made because of inadequate history taking and superficial exam than any other cause
tre
why does case history matter in ped aud assessmens?
Understanding the Child: Provides essential information about the child’s development and health, offering insights into their cognitive and developmental status and helping estimate their auditory skills.
Understanding the Family: Enables the audiologist to understand the parents’ concerns, needs, and assessment expectations, and helps build rapport with family and caregivers, which is crucial for effective counseling.
Observational Opportunities: Allows the audiologist to observe the child’s behavior and note interactions with family members and others.
Guidance for Assessment: Informs the audiologist about the nature of auditory complaints (e.g., unilateral/bilateral, acute/chronic), assists in formulating clinical testing strategies, and highlights possible contributing factors to hearing disorders.
A good case history is a valuable tool and an often-overlooked part of an audiologic evaluation.
true
Failure to obtain sufficient history information may reduce the
quantity and quality of data obtained from the evaluation and diminishes the role of both the assessment and the audiologist to a technical one rather than a professional and diagnostic one.
Accurate diagnosis of hearing loss relies on interpretation of a test battery within the context of \
the child‘s medical and/or developmental history.
what are common pitfalls during case hx collection
providing false reassrurance
giving unwanted advice
using authority
using why questions
using professional jargon
using leading or biased questions
talking too much
interrupting or changing the subnect
what is the interview part of case history information
Patient is asked about his or her health in an organized fashion. The patient is allowed to discussed any problem fully.
what is a disadvantage to interview case history
takes and adds time to interview, parents/PTs talk and some are really talkative and can add up to 15-20 minutes to just get information
what is a disadvantage to health questionnaire
information can be inaccurate
This approach uses the advantages of both techniques and reduces the disadvantages after reviewing a completed health questionnaires, the audiologist discusses the response with the patient.
combination of interview and health questionnaire
Common examples of chief complaints
rule out hearing loss as the result of the s/l delay
do screenings & refer for failed screenings
failed NBHS
what is a chief complaint and what would audiologists ask
An audiologist might initially ask a simple question to elicit the chief complaint, such as: “What brought you to see us today?” “”What seems to be the problem”.
waht type of questions should or should not be used during chief complaints
Open questions: Always start with an open-ended question and take the time to listen to the patient’s ‘story’.
“How can I help you?”
“You said you have tried hearing aids in the past, but you were not satisfied, can you tell me more about this?”
Closed questions: Once the patient has completed their narrative to closed questions which clarify and focus on aspects can be used.
“Are you still taking the aspirin your GP prescribed?”
“Do you still have pain in your left ear?”
Leading questions: Questions based on your own assumptions that lead the patient to the answer you want to hear. These should not be used at all.
“You are not allergic to anything are you?”
“You use your hearing aid regularly as you should, right?”
A complete history covers several content areas, and depending on the reason for the evaluation, emphasizes different segments of information.
true
components of a case history
PT info
prenatal & birth history
med hx
growth & physical development
educational progress
speech & hearing milestones
hearing and aud behavior
amplification
dizziness
Case history: Adults vs. Ped. what are the differences?
have to treat them differently because their needs are different
different forms for the parents based on their age because we look at their age and development differently
what is the purpose of otoscopy
Ensuring that the ear canal is free of debris through visual inspection
otoscopy is the important first step for diagnostic assessment of hearing at any age in order to:
Understand the physical influences that can impact the outcome of the audiologic evaluation.
Determine that it is safe to perform audiologic testing involving the placement of probe tips and earphones into the ear canal.
sizes of speculum
2mm, 3mm, 4mm, and 5mm
best view of child’s ear canal
The best view will be obtained with a speculum tip slightly smaller than the ear canal diameter, allowing it to be inserted into the canal while providing the maximum lumen for viewing purposes
Children respond to people who enjoy and care about them!
true
Pediatric audiologist need to:
Communicate on their level and be creative
Engage the parents
Build trust
Make sure that you have the temperament, personality, and dedication required!
should you ask the child for permission
NO
Inspect your patient’s ears for
Shape (malformation)
Placement
Redness
Swelling
Discharge
Pits/tags
Cuts, scrapes, bruises
Foreign object
Turn the light on and then straighten the patient’s ear canal by pulling the pinna
down and back.
what is a tip to get the child to give you the ear you want to look into
If unable to turn child’s head, wiggle the otoscope light in front of the eyes and then move it to the opposite side of the ear you want to look in. The child will often track with the light and turn their head so their ear is then right in front of you.
Have a parent stabilize the head!
For infants and younger children (under 3),
have the child sit on the parent’s lap, with the parent using a “comfort hold” to support the side of the child’s head against the parent’s chest.
Protects the child’s head from sudden movements that could cause injury
Hugging the child reduces anxiety and increases cooperation.
For older children (older than 3 yrs)
Prepare for the procedure by inviting them to play with the otoscope, demonstrating how it works, and explaining how and why they need to stay still.
Attach the largest ear speculum that the ear will accommodate and twist it on securely.
Inspect the ear canal to ensure:
Clear enough to allow the insertion of an admittance probe tip
Free from excessive cerumen
Free from other obstructions such as PE tubes that have been extruded from the tympanic membrane
Not draining excessively so as to plug the probe
Watch for:
Foreign object
Redness
Swelling
Cerumen impaction
Bony growth
Examination of the tympanic membrane
Identify the landmarks of the tympanic membrane can be seen (light reflex, umbo, and short process of malleus). Look for the pearly grayish/pinkish color
Watch for
Inflammation, retracted, bulging
Perforation
PE tube is in place or extruded
Scarring or tympanosclerosis of the tympanic membrane.
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