Pediatric Otoscopy and Case History Flashcards
Do audiologists strive to follow a humanistic approach?
Yes, this care is focused and centered on the patient and family and not based primarily on the preconceptions and protocols of the provider
Should we try to keep the patients thoughts and feelings in mind?
Yes
They are probably less at ease and more frightened than you are
They probably think their problem is more serious than you do
They are probably coming to see you because they believe you can help them
Can first impressions make a lasting impression with patients?
Yes
If in a bad mood or distracted during a consultation, will we end up making a history rather than taking a history?
Yes
We need to prepare ourselves mentally to see patients
Are more errors made because of inadequate history-taking than any other cause?
Yes, this is a very important aspect to an exam
What is a case history?
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
Why does case history matter for audiologists?
It allows us to have a better understanding of the child’s development and health
It allows us to understand the parent’s concerns, needs, and assessment expectations
It allows us to observe the child’s behavior
It informs the audiologist about the nature of the auditory complaints and what tests to perform
What are some consequences of not performing a good case history?
It may reduce the quantity and quality of data obtained from the evaluation
Diminishes the role of audiologist to technician rather than professional
May affect their ability to give an accurate diagnosis
What are some common pitfalls during case history collection?
Providing false reassurance
Giving unwanted advice
Using authority
Using why questions (could come off as judgmental)
Using professional jargon
Using leading or biased questions
Talking too much
Interrupting or changing the subject
What are the different ways to collect information?
Interview
Health questionnaire
Combination
What are some disadvantages to an interview case history?
Parent bias
Easy to forget information or not mention specific concerns
Adds 15-20 minutes onto the appointment
What are some disadvantages of doing a questionnaire case history?
May bleed into the appointment time
Patients need to show up early
May not show patients specific concern on the questionnaire
Could record inaccurate information due to the number of forms and fatigue
When collecting the chief complaint, what type of questions should you start with?
Open questions
“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?”
When collecting the chief complaint, how are closed questions used?
To clarify and focus on aspects that can be used
“Are you still taking the aspirin your GP prescribed?”
“Do you still have pain in your left ear?”
When collecting the chief complaint, how are leading questions used?
Based on our own assumptions and lead the patient to an answer you want
“You are not allergic to anything are you?”
“You use your hearing aid regularly as you should, right?”
These should never be used
What are the different categories that need different case history questions?
0-4 years
4-17 years
Adults
Vestibular
What are the different components that should be included in the case history?
Patient information
Prenatal and birth history
Medical history
Growth and physical development
Educational progress
Hearing and auditory behavior
Speech and hearing milestones
Amplification
Dizziness
What is the purpose of doing pediatric otoscopy?
Ensure the ear canal is free of debris
Understand the physical influences that can impact the outcome of the evaluation (conductive)
Determine if it is safe to perform audiologic testing
What size ear tip do you use for pediatric otoscopy?
2mm
3mm
4mm
5mm
How do you know what size speculum to use?
Should be selected based on an observation of the child’s ear
Choose the largest tip that you can fit in the ear
What are some things that pediatric audiologists need to do?
Communicate on their level and be creative
Engage the parents
Build trust with the child
Make sure that you have the temperament, personality, and dedication required
Should you ask the child for permission?
No
Instead you should distract them with videos or toys, tell them what you’re going to do
How do you prep young children (under 3) for otoscopy?
Have the child sit on the parent’s lap with the parent using the “comfort hold”
One hand on head and other on tummy
What does the comfort hold do for the child?
Protects the child’s head from sudden movements that could cause injury
Hugging the child reduces anxiety and increases cooperation
How should you perform otoscopy in children older than 3?
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
What are you looking for in a patient’s ear?
Shape (malformation)
Placement
Redness
Swelling
Discharge
Pits/tags
Cuts, scrapes, bruises
Foreign object
What is a tip if the child is not turning their head?
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!
How should you pull a pediatric ear?
Down and back
