Examination of the Ear

Introduction

  1. Wash your hands and introduce yourself.
  2. Check the patient’s name and DOB.
  3. Explain that you want to have a look in their ear and that, whilst it may not be comfortable, it should not be painful (and if it is at any point, the examination can stop).  Also ask if they have any pain at the present.
    1. NB In the history, prior to examination, you should also have asked about hearing loss, trauma/irritation, any aids, etc.

Prior to formal functional testing, use the whisper test (whispering in the ear) to crudely assess hearing loss.

Rinne’s Test

  1. Assessing each ear individually and using a 512 (or 256) Hz tuning fork
    1. Ask the patient if they can hear it ring with the fork initially placed on the angle of the jaw.
    2. Ask them to tell you when they can no longer hear it, then bring the tuning fork close to their ear and ask them if they can still hear it.
    3. If they can (indicating that air is louder than bone conduction), this is normal and is a positive Rinne’s test.
      1. If they cannot, re-ring the fork and test bone and air conduction seperately, and ask which the patient hears the loudest.  A negative Rinne’s test is suggestive of conductive hearing loss.

Weber’s Test

  1. Using the 512 (or 256) Hz fork, ring and place directly in the middle of the forehead, and ask if the sound is heard equally in both ears.
    1. Weber’s and Rinne’s can be used in conjunction to give a more accurate picture of what is going on:

Inspection/Palpation/Otoscopy

  • Physical examination
    • Examine the external ear (behind the ear, pinna, external auditory meatus etc)- look for any discharge (purulent, bloody, serous), wax, scars, hearing aids
    • Palpate the pinna- pull back and observe for any tenderness; the mastoid process for the same
    • You may also want to examine the neck for lymphadenopathy at this point (can be done later)
  • Otoscopy
    • Before inserting the otoscope, make sure to straighten the auditory canal by pulling the ear up and back (NB this is not necessary in young children)
    • Holding the otoscope like a pen, gently insert into the patient’s ear
      • Comment on the wall of the canal
        • Any flaking, swelling, wax, inflammation, foreign body, diameter (narrow/wide), obstruction (?cerumen)
      • Examine the membrane, commenting onLight reflex
        • Colour (pearly pinky gray- normal; red- inflamed)
        • Tympanosclerosis
        • Shape (bulging/indrawing)
        • Any fluid level?
        • Any perforations?
        • Any foreign body? (including Grommet’s insertion)

ear_drum

2 thoughts on “Examination of the Ear”

    1. It was worked out.
      Rinne’s works out whether there is a conductive hearing loss and Weber’s is used to lateralise the ear and try to distinguish between conductive and sensorineural hearing loss.

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