Table of Contents Introduction Inspection Palpation OtoscopyHearing tests Lastly To complete Common ear pathologyTest your knowledge 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 External ear anatomy 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. Test your knowledge What is a cholesteatoma? Oops! This section is restricted to members. What is Ramsay Hunt syndrome? Oops! This section is restricted to members. What is a Grommet and what are the indications? Oops! This section is restricted to members.
