DEAFNESSMUSTAFA MANHAL ALWARD

EAR EXAMINATION

1- Auricle:

Inspect for deformities, lumps, skin lesions

if there’s ear pain or discharge then move the auricle up and down, press the targus and behind the ear << Tug test: painful only in otitis externa

2-Ear Canal and Drum: by the use of Otoscope

Inspect the eardrum, noting its color and contour. The cone of light to orient you.

Identify the handle of the malleus, noting its position, and inspect the short process of the malleus

3- Auditory Acuity: Close one ear and talk, do it for both ears

4- Test Air and Bone Conduction: If auditory acuity is impaired

1-2-

1- Weber test (Test for

lateralization ):

Place the base of the

vibrating tuning fork firmly on

top of the patient’s head or

on the midforehead.

Ask where the patient hears

it: on one or both sides.

Normally the sound

is heard in the midline or

equally in both ears. If

nothing is heard, try

again, pressing the fork more firmly on the head.

2-Rinne Test {Compare air conduction (AC) and bone conduction (BC)}:Place the base of the vibrating fork on the mastoid bone, behindthe ear and level with the canal. >> When the patient can no longer hearthe sound, quickly place the fork close to the ear canal, Here the “U” of the fork should face forward.Normally the sound is heard longer through air than through bone (AC > BC).

Usually detected on neonatal Screening

Causes:

Genetic

Intrauterine infection, e.g. rubella

Drugs given in pregnancy, e.g. streptomycin

Birth asphyxia

Meningitis

Severe neonatal jaundice

Congenital deafness

Temporary deafness due to middle ear infections.

Decrease hearing, noticed by parents or teachers—take it seriously

Deafness causes long-term speech, language, behavioural problems.

Causes:

If no earache Bilateral glue ear, impacted wax; hereditary cause; sequel of meningitis, head injury, or birth complications

If earache Acute otitis media, impacted wax

Management:

History, examination, assess development (including speech and language), consider referral to ENT.

Childhood-onset deafness

Presentation hearing loss develops with increasing

Problems in understanding others when there is background noise. Tinnitus

may be the presenting problem(Depends on the cause)

Useful screening questions

• Do other people mumble a lot?

• Do you find yourself frequently saying ‘pardon’?

• Does the family say the TV is too loud?

• Do you miss hearing the doorbell or ‘phone?

• Do you occasionally get the wrong end of the stick in a conversation?

Management Examine the drum; exclude wax; consider post-nasal space

tumour. If no self-limiting cause is found, refer for a hearing test to quantify

hearing loss and assess suitability for hearing aid.

Adult-onset deafness

Presbyacusisbilateral symmetrical sensorineural deafness in the over 50s.

Deafness is gradual in onset.

High frequencies are more severely affected, so speech discrimination, particularly of high-pitched voices,

is lost first.

Examination is normal. Refer for an audiogram to confirm diagnosis and then for a hearing aid if

appropriate.

OtosclerosisBilateral conductive deafness due to adherence of the

stapes footplate to the bone around the oval window.

If deteriorates in pregnancy, avoid prescribing combined contraceptives.?

Refer to ENT for assessment to replace the stapes with an implant.

Noise-induced deafness

Caused by exposure to noise >85dB.

May occur in work or non-work settings (e.g. firearm sports).

Immediate indications are ringing in the ears/muffling of hearing after exposure.

Management

Refer to audiology.

Avoid further excessive noise exposure.

Hearing aids may help.

A 37-year-old woman comes to your office for assessment of hearing loss. She has

had problems intermittently for the past 12 months.

On examination, the Weber tuning fork test lateralizes to the right ear, and the Rinne

tuning fork test is negative in the right ear (bone conduction is greater than air

conduction [BC > AC]).

This suggests which of the following?

a. a right-sided conductive hearing loss

b. a left-sided conductive hearing loss

c. a right-sided sensorineural hearing loss

d. a left-sided sensorineural hearing loss

e. a or d

A 43-year-old man comes to your office for assessment of hearing loss. He has had hearing difficulties for

the past 4 years.

On examination, the Weber tuning fork test lateralizes to the left ear. The Rinne tuning fork test is

normal bilaterally (AC > BC).

This suggests which of the following?

a. a right-sided conductive hearing loss

b. a left-sided conductive hearing loss

c. a right-sided sensorineural hearing loss

d. a left-sided sensorineural hearing loss

e. b or c