Ear and Hearing

Ear and Hearing

There are different ways to perform an examination of the ears. This is one example of a structured examination.

Equipment

  • Tuning fork 512hz
  • Otoscope
  • Disposable otoscope speculumsu00a0

Introduction

u00a0

  • Wash hands with alcohol gel
  • Introduce yourself to the patient
  • Confirm the patientu2019s name and date of birth
  • Obtain consent to examine the patient and explain what this will involve
  • Ask for a chaperone if required
  • Position patient u2013 sit in chair
  • Ask the patient if they have any pain
  • Gather equipmentu00a0

Inspection

  • Hearing aids, BAHA, cochlear implant
  • External ear:u00a0
    • Pinna – scar, swellings, deformity, piercings, signs of infection
    • Pre-auricular – pre-auricular sinus/pits, scars
    • Post-auricular u2013 scars, tenderness, erythema, swelling, pain

Otoscopy

  • External canal u2013 wax, swelling, inflammation, discharge
  • Tympanic membrane u2013 intact/perforation, colour u2013 erythema, bulging, tympanosclerosis, light reflex, presence of grommet, retraction

Hearing

Weberu2019s and Rinneu2019s tuning fork test

Make sure you use a 512Hz tuning fork for both tests. The 512Hz tuning fork gives the best balance between decay and tactile vibration. There may be a selection of tuning forks in the station.u00a0

Weberu2019s test

  1. Explain to the patient that you are going to test their hearing with a tuning forku00a0
  2. Vibrate the tuning fork by hitting it on your knee or elbow (never the patientu2019s knee or the table!)
  3. Place the tuning fork firmly on the patient’s forehead in the midline or on the vertex of the skull.u00a0
  4. Ask the patient u201cwhere do you hear the sound?u201d
    1. Midline – Normal hearing or equal bilateral hearing loss
    2. Sensorineural deafness – Loudest on the side of the UNaffected ear
    3. Conductive deafness – Loudest on the side of the AFFected ear
  1. Explain to the patient that you are going to test their hearing with a tuning forku00a0
  2. Vibrate the tuning fork by hitting it on your knee or elbow (never the patientu2019s knee or the table!)
  3. Place the tuning fork firmly on the patient’s mastoid tip and confirm they can hear the sound.u00a0
  4. Ask them to tell you when they can no longer hear the sound.u00a0
  5. When they can no longer hear the sound remove the tuning fork and face the prongs towards the test ear 2cm away and ask if they can hear the sound. This tests air conduction.
    1. Positive Rinneu2019s = air conduction > bone conduction – seen with normal hearing ear or in sensorineural deafness where bone and air conduction are reduced equally.
    2. Negative Rinneu2019s = bone conduction > air conduction – seen in conductive hearing loss.
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