Pediatric otoscopy and case history Flashcards
Initial patient encounter
first impression are often lasting impression
audiologists strive to follow a humanistic approach in providing clinical services. Humanistic care is focused and centered on the patient and family and not based on primarily on the preconceptions and protocols of the healthcare provider
prepare yourself mentally (4)
1) keep in mind patients are waiting for you
2) they are proabably less at ease and more frightened than you are
3) they probably think their problems is more serious than you do
4) They are probably coming to see you because they believe you can help them
Why are more errors made?
Because of inadequate history taking and superficial exam than any other cause
case history defined
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 patients illness and his/her attitude towards them
Why case history matters in pediatric audiological assessments
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
Why case history matters in pediatric audiological assessments
Understanding the family:
Enables the audiologists to understands the parents concern, needs, assessment expectations, and helps build rapport with family and caregivers which is crucial for effective counseling
Why case history matters in pediatric audiological assessments
Observational Opportunities:
Allows the audiologists to observe the child’s behavior and note interactions with family members and others
Why case history matters in pediatric audiological assessments
Guidance for Assessment:
Informs the audiologists about the nature of auditory complaints (unilateral/bilateral/ acute/chronic) assists in formulating clinical testing strategies and highlights possible contributing factors to hearing disorders
consequences
common pitfalls during case history collection
providing false reassurance
giving unwanted advice
using authority
using “why” questions
using professional jargon
using leading or biased questions
talking to much
interrupting or changing the subject
collecting case history information
Interview
health questionnaire and combination
Chief complaint
audiologists might make initially ask a simple question to elicit the chief complaint
” what brought you to see us today”
Chief complaint:
open question
closed question
leading question
How can I help you
Do you still have pain in your left ear
You used your hearing regularly as you should, right?
Components
complete history covers several content areas and depending on the reason for the evaluation, emphasizes different segments of information
Examples of components
patient information
prenatal and birth history
medical history
growth and physical development
educational progress
hearing and auditory behavior
speech and hearing milestones
amplification
dizziness
otoscopic examination
ensuring that the ear canal is free of debris through visual inspection is an important first step for diagnostic assessment
2 reasons for otoscopic examination
understand the physical influences that can impact the outcome of the audiologic evaluation
determine that it is safe to preform audiologic testing involving the placement of probe tips and earphones into the ear canal
selecting the speculum
should be observed based on childs external ear
best view will be obtained with a speculum tip slightly smaller than the ear canal diameter allowing it to be isnerted into the canal while providing the maximum lumen for viewing purposes
pediatric audiologists 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
preparation
for infants and younger children under 3
children sit on patients lap
- protects the childs head from sudden movements that could cause injury
- hugging child reduces anxiety and increases cooperation
preperation
for older children
invite them to play with otoscope demonstarting how it works and explaing how and why they need to stay still
examination of the ear
shape (malformation)
placement
redness
swelling
discharge
pits/tags
cuts/scrapes, bruises
foreign object
Examination of the ear canal
clear enough to allow the interstion of an admittance probe tip
free from excessive cerumen
free from other obstructions such as PE tubes that haven been extruded from the tympanic membrane
examination of the ear canal
watch for
foreign object
redness
swelling
cerumen impaction
bony growth
