Ear examination

Clinical examination > Other

Introduction

Wash hands
Introduce self
Ask Patient’s name, DOB and what they like to be called
Explain examination and obtain consent
Explain procedure, asking them to stay completely still when you use the otoscope
Position patient – seat at same level as you with both ears accessible
Note and remove any hearing aids
Prepare otoscope, speculum, 512Hz tuning fork

Inspection

General inspection: symmetry, position (low set = genetic syndromes), shape
Close ear inspection
- Skin in front of and behind ear: skin tags, erythema, scars, preauricular sinuses/pits
- Pinna: any skin changes (e.g. neoplasia), deformities (e.g. accessory auricle), scars, erythema (erysipelas, chondritis),perichondrial haematoma (trauma)
- External auditory meatus: erythema, pus/discharge (otitis externa)
- Mastoid: erythema/swelling (mastoiditis)

Palpation

Pinna: tug gently (tenderness may suggest mastoiditis)
Mastoid: palpate mastoid (tenderness may suggest mastoiditis)
Lymph nodes: feel for pre/postauricular lymphadenopathy (infection)

Otoscopic view of right tympanic membrane

Otoscopy

Apply new speculum to otoscope and turn on light
Hold the otoscope like a pencil (in your right hand for the right ear and vice versa) with the handle pointing anteriorly
Start with non-affected ear
Pull the pinna up and backwards (down and backwards in children) with your other hand to straighten the external auditory canal
Insert the speculum tip into the external auditory meatus
Rest the ulnar border of your hand on their cheek to stabilise it
Gently advance the speculum while looking through the otoscope
Look at:
- Auditory canal: wax, foreign bodies, skin quality (thick white growth = cholesteatoma), erythema/discharge (otitis externa)
- Tympanic membrane
  - Colour: should be pinkish-grey (erythematous = otitis media; scarred = tympanosclerosis)
  - Structure: look for perforation, tympanostomy (‘grommet’), bulging (otitis media), or retraction (Eustachian tube dysfunction)
  - Fluid (effusion, haemotympanum)
- Behind tympanic membrane for any visible features (pars tensa, pars flaccida, handle/lateral process of malleolus, cone of light)
Slowly withdraw the otoscope
Dispose of speculum in clinical waste bin

Hearing tests

Crude hearing test

Ask patient to occlude one ear

Whisper a number, starting peripherally and then moving closer towards their ear

Ask them to tell you the number when they hear it

Repeat on other side

Weber’s test

Use a 512Hz tuning fork

Twang the prongs and place the round base of the fork on the patient’s forehead between their eyes

Ask them if one side is louder than the other (if one side is louder, either that side has a conductive deficit, or the contralateral side has a sensorineural deficit – Rinne’s test can then determine which)

Rinne’s test

Use a 512Hz tuning fork

Twang the prongs and place the round base of the fork on the patient’s mastoid process

Ask them to tell you when the sound stops

Then, place the prongs near the patient’s ear

Ask them if they can then hear it again – air conduction should be louder than bone conduction (if they cannot hear it, there is a conductive deficit in that ear)

Lastly

Test facial nerve function if serious pathology observed

To complete

Thank patient
Summarise and suggest further investigations you would consider after a full history (e.g. audiometry, tympanometry)

Common ear pathology

Oops! This section is restricted to members. Click here to signup!

Test your knowledge

What is a cholesteatoma?

Oops! This section is restricted to members. Click here to signup!

What is Ramsay Hunt syndrome?

Oops! This section is restricted to members. Click here to signup!

What is a Grommet and what are the indications?

Oops! This section is restricted to members. Click here to signup!

No comments yet

Leave a Reply Cancel reply

You must be logged in to post a comment.

Don't take our word for it

"The stations you provide are strikingly similar to those I came across during my medical school finals (some even verbatim!), and I have tried many other exam platforms. I'm truly grateful for your priceless support throughout my final couple of years at medical school!"

Raza Q

"It has absolutely everything for medical school, so many histories with detailed differential diagnoses, how to approach emergencies, commonly prescribed drugs..every kind go examination you’ll ever need in osces"

John R

"Thank you SO MUCH for the amazing educational resource. I’ve tried lots of platforms and books with mock OSCE stations and yours is by far and away the best I’ve tried"

Ed M

"Get this right away. So helpful for OSCEs but also general clinical learning and understanding. Wish I had brought it sooner"

Emma W

"Without a doubt, your platform outshines all other OSCE resources currently available. In all honesty, I can confidently attribute my success in securing a distinction in my finals to OSCEstop."

Harish K

"OSCEstop distinguishes itself from many other platform banks by offering a wealth of questions that mimic the demanding and complex aspects of our finals. This platform played a crucial role in ensuring I was ready for the level of difficulty that awaited me in my final exams."

Natasha W

Learning notes: 246

Stations available: 207

Qbank questions: 2252

Conditions: 558

More: