![]() ![]() ![]() If not, increase the volume as follows until the patient correctly identifies 50% or more words.Ĭonversational: mild-moderate hearing loss You can then move on to test the contralateral ear. If the patient correctly identifies 50% or more words at the quietest threshold (whisper at arm's length) they have normal hearing in this ear. Say the test words, and ask the patient to repeat them back to you at a full arm's length. On the side of the test ear, shield the patient's eyes with one hand, and gently & repetitively press on the tragus of the non-test ear, using your other hand passed behind the patient's head. Despite this, tuning forks are most often useful nowadays to clarify inaccurate or equivocal pure-tone audiograms!Ĭhoose words, each with two balanced syllables (e.g. Note that no test is perfect, and tuning forks can occasionally be misleading - if in doubt, request formal audiometry. This situation is known as the "false negative" Rinne. Normal Rinne's bilaterally and Weber's central = normal, or symmetrical sensorineural hearing lossĪbnormal Rinne's on the left and Weber's lateralising to the left = conductive hearing loss on the leftĪbnormal Rinne's on the left and Weber's lateralising to the right = sensorineural hearing loss on the left. Record whether the result is central/equivocal, left or right. Strike the tuning fork and hold the base on the patient's forehead. Ask the patient where they can hear it loudest - in the middle, left or right. Since this is confusing, we suggest you use 'normal' and 'abnormal', supplemented with shorthand where appropriate.) (For Rinne's test, a normal test is known as a positive test - the opposite of most other medical tests. It is normal to have better air conduction than bone conduction. Record whether the result is normal or abnormal. If they can, the test is positive (=normal) Immediately move the tuning fork in front of the ear (2 cm away from the meatus)Īsk the patient whether they can still hear the tuning fork Strike a 512 Hz tuning fork against your thigh, knee or forearm, then place the base against the mastoid bone until the patient tells you it can no longer be heard. In chronic ear disease, you should examine the ear with a binocular microscope, and perform careful microsuction of any wax, keratin or discharge.Įxplain to the patient what you need them to do. You should hold the otoscope correctly: like a pen your right hand to the patient's right ear and vice versa using your little finger to balance your hand against their cheek. Tympanic membrane: look at the four quadrants (in particular the pars tensa) look for perforations, retraction pockets, accumulation of keratin, crusts, bulging, grommets and the colour of the tympanic membrane (is it dull, erythematous or bloody or can you see a fluid level?). Note whether the mastoid is boggy/swollen or firm.Įxternal auditory canal: look for wax erythema swelling flaky skin discharge (is it custard-like mucopurulent, full of black Aspergillus spores or watery?) foreign body masses (furuncle, exotoses, osteoma) vesicles granulomata. Gently palpate the tragus and the mastoid for tenderness. ![]() Note the use of hearing aids (behind the ear, in the ear, BAHA or cochlear implant) and remember to ask the patient whether they use hearing aids if they are not present. Look carefully for pre- or post-auricular scars - they can be very faint. Inspect each pinna in turn for deformity or swelling eg cauliflower ear. Inspect for erythema or cellulitis, flaky skin, ear discharge, skin lesions, subcutaneous masses and pre-auricular sinuses. Inspect from the front for any asymmetry of the pinnas. Introduce yourself and confirm the patient’s identityĮxplain that the examination of the ear which will include using an otoscope and tuning forkĬheck if there is any pain or discharge from the ear
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