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Hearing Assessment and Otoscopy

Discussion in 'Otolaryngology' started by Ghada Ali youssef, Jan 12, 2017.

  1. Ghada Ali youssef

    Ghada Ali youssef Golden Member

    Dec 29, 2016
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    • Hearing assessment and otoscopy frequently appear in OSCEs. You’ll be expected to pick up the relevant clinical signs using your examination skills. Technique is very important in this station, so ensure you’ve practiced how to hold and use an otoscope before your exam. This guide provides a clear step by step approach to the station.


    • Wash hands
    • Introduce yourself
    • Confirm patient details – name / DOB
    • Explain examination
    Today I’d like to examine your ears, this will involve me having a look inside your ears using a special piece of equipment known as an otoscope. In addition I’ll also be assessing your hearing using a number of different tests
    • Gain consent Does everything I’ve said make sense? Are you happy for me to go ahead?

    Gross hearing assessment
    • Ask the patient if they have noticed any change in their hearing recently.
    • Explain that you’re going to say a word or number and you’d like them to repeat it back to you.
    1. With your mouth approximately 15cm from the ear, whisper a number or word.

    2. Mask the ear not being tested by rubbing the tragus.

    3. Ask the patient to repeat the number or word back to you.

    4. If the patient repeats the correct word or number, repeat the test at an arm’s length from the ear (normal hearing allows whispers to be perceived at 60cm).

    5. Assess the other ear in the same way.

    Weber’s test
    1. Tap a 512 Hz tuning fork and place in the midline of the forehead
    2. Ask the patient “Where do you hear the sound?“

    • Normal – sound is heard equally in both ears
    • Neural deafness – sound is heard louder on the side of the intact ear
    • Conductive deafness – sound is heard louder on the side of the affected ear

    Rinne’s test
    1. Tap a 512 Hz tuning fork and place at the external auditory meatus (EAM). Ask the patient if they are able to hear it (air conduction).
    2. Now move the tuning fork (whilst still vibrating), placing its base onto the mastoid process (bone conduction).
    3. Ask the patient if the sound is louder in front of the ear (EAM) or behind it (mastoid process)
    • Normal – Air conduction > Bone conduction (Rinne’s positive)
    • Neural deafness – Air conduction > Bone conduction (both air and bone conduction ↓ equally)
    • Conductive deafness – Bone conduction > Air conduction (Rinne’s negative)

    Ask the patient if they have any ear discomfort (if so examine the non-painful side first).

    - Pinnae

    • Inspect the pinnae – note any deformity / ear piercings
    • Inspect behind the pinnae – skin changes / erythema
    - Ear canal / tympanic membrane
    Ensure the light is working on the otoscope and apply a sterile speculum (the largest that will comfortably fit in the external auditory meatus).

    1. Pull the pinna upwards and backwards – to straighten the external auditory meatus

    2. Position otoscope at the external auditory meatus:

      • Otoscope should be held in your right hand for the patient’s right ear and vice versa
      • Hold the otoscope like a pencil and rest your hand against the patient’s cheek for stability
    3. Advance the otoscope under direct vision

    4. Look for any wax, swelling, erythema, discharge or foreign bodies

    5. Examine the tympanic membrane:

      • Colour – pearly grey and translucent (normal) / erythematous (inflammation)
      • Erythema or bulging of the membrane? – inspect for a fluid level e.g. otitis media
      • Perforation of the membrane? – note the size of the perforation
      • Light reflex present? – absence / distortion may indicate ↑ inner ear pressure e.g. otitis media
      • Scarring of the membrane? – tympanosclerosis – can result in significant hearing loss
    6. Withdraw the otoscope carefully

    7. Discard the otoscope speculum into a clinical waste bin


    To complete the examination

    • Thank patient
    • Wash hands
    • Summarise findings

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    Last edited by a moderator: Dec 21, 2018

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