Investigations

• What are the 2 tuning forks tests?

  Weber's

  Rinne's
• What is Weber's test?

  Place vibrating tuning fork base in the middle to pts forehead

  Ask where they hear the sound

  NORMAL = central

  SENSORINEURAL = sound is louder in unaffected ear

  CONDUCTIVE = sound is louder in affected ear

  
• What is Rinne's test?

  Place vibrating tuning fork on mastoid process & ask if pt can hear it

  Then get pt to tell you when they stop hearing the sound

  When it stops, place the tuning fork at the external auditory meatus & ask if you can still hear it

  NORMAL =AC > BC (+ve)

  SENSORINEURAL = AC > BC (false +ve)

  CONDUCTIVE = BC > AC (-ve)

  
• Fill in the blanks

  A) Positive

  B) Negative

  C) False positive

  D) Negative

  E) equal

  F) affected

  G) unaffected

  H) 'good'

  
• What is the air-bone gap?

  Difference between air conduction & bone conduction

  Considered a 'gap' when there is a greater than 10 dB at a given frequency
• What could cause an air-bone gap?

  Conductive hearing loss

  Mixed hearing loss

  Outer/middle ear diseases (e.g. TM perforation)
• What is a pure tone audiogram?

  Hearing test under ideal listening conditions in a soundproof booth. 
• What are the hearing thresholds?

  Normal = can hear quiet sounds of < 20 dB

  Mild hearing loss = hearing loss 20-40 dB

  Moderate hearing loss = hearing loss 41-70 dB

  Severe hearing loss = 71-95 dB

  Profound hearing loss = hearing loss over 95 dB
• What is shown in this audiogram?

  Normal hearing

  
• What is shown in this audiogram?

  Sensorineural hearing loss

  
• What is shown in this audiogram?

  Conductive hearing loss

  Air-bone gap present

  
• What is shown in this audiogram?

  Presbycusis (age-related hearing loss)

  Bilateral hearing loss above 2000 Hz

  
• Why was a CT done in cholesteatoma?

  Used to exclude perforation of bony tegmen

  If tegmen is breached, can lead to many problems (e.g. CSF leak, meningitis)
• What is important in an ear history?

  Previous ear trauma/surgery?

  Recurrent ear infections

  Systemic conditions associated with hearing loss

  Drugs - aminoglycosides, aspirin, furosemide

  Occupation (any significant exposure to loud noise)
• Describe the process of otoscopy?

  Start with pts 'better' ear

  Pull pinna up & back to straighten external auditory canal

  Inspect external auditory canal (for wax, erythema, oedema, discharge, foreign bodies)

  Inspect 4 quadrants of tympanic membrane (colour, shape, light reflex, perforation & scarring)

  Repeat on other ear
• What is shown in the image?

  Normal TM

  
• What is shown in the image?

  Cholesteatoma (normally seen in TM attic)

  
• What is shown in the image?

  Otitis media with effusion

  
• What do you palpate in an ear examination?

  Auricle, tragus, mastoid
• When is cholesteatoma suggested?

  Chronic purulent ear discharge

  Hearing loss/tinnitus

  Otalgia

  Vertigo (more severe disease)

  Facial nerve involvement (more severe disease)

  Crust/keratin in attic of TM

  TM may be perforated
• What are the differential diagnoses for otitis media with effusion?

  Acute otitis media

  Mastoiditis

  Otitis externa

  Referred pain

  Otitis barotrauma
• Decribe facial nerve (CN VII) testing.

  Sensory

  • any recent changes in their sense of taste?

  Motor

  • any changes in their hearing (due to paralysis of stedius muscle)
  • inspect for asymmetry (forehead wrinkles, nasolabial folds, angle of mouth)
  • facial movements -> raise eyebrow, close eyes (don't let me open them), blow out cheeks (don't let me deflate them), smile, pursed lips
• When are hearing tests done?

  Newborn hearing screening -> routine for all children

  9 months - 2.5 years -> referred for testing if concerns rasied in health & development

  4/5 years -> some children may have a test when they start school
• How is tegmental thinning diagnosed?

  CT or MRI
• What is shown in the image?

  TM perforation