🦻

Question 1

What do you assess in direct light inspection of the ears ?

Answer 1

Alignment, symmetry of position of ears
Skin, color, swelling
Presence of secretion, cerumen, swelling

Question 2

What do you assess in otoscope inspection ?

Answer 2

Skin : color, swelling, discharge
Foreign bodies
Eardrum (color, alignment), Pollitzer luminous cone, pars flaccida, malleus, incus
Presence of air bubbles, serous fluid pus, blood, sclerosis, perforated eardrum

Question 3

What do you palpate in the ear ?

Answer 3

Swellings in : auricle, temporal bone, auricle back groove

Palpate mastoid always
Palpate auricle on indication

Question 4

Technique of otoscope :

Answer 4

Check light and place clean specula. Start with unaffected ear.

Pull auricle slightly upward and backward to stretch auditory canal. Pull auricle flat against skin.
Insert otoscope with same hand as the ear side.
Place finger against head for support

Question 5

Technique of whispered voice test :

Answer 5

Sit behind patient. Whisper 6 combination of number and letter in each ear

Question 6

Technique of Rinne’s test :

Answer 6

Strike tuning fork (512). Place stem against mastoid and ask patient when they cannot hear it anymore.
Then place tuning fork 2 cm front of ear with parallel prong.

Question 7

Result of Rinne’s test

Answer 7

Positive test = normal = best in air conduction
Negative test => conductive hearing loss

Question 8

Technique of Weber’s test :

Answer 8

Strike tuning fork, place it at the center of patient forehead. Ask where they perceive the sound.
Sound only on one side => pathological

No sound => repeat on bridge of nose then upper teeth

Question 9

Result of Weber’s test

Answer 9

Conductive hearing loss : on the side that hear
- physical advantage hearing by bone conduction because air conduction is filtered out.

Sensorineural hearing loss : sound heard on healthy ear, the sick ear does not ear

Question 10

Technique of Tilt test - Positioning test - Dix Hallpike manoeuvre

Answer 10

Patient sit on examination table, leg stretched. When they lie back their head project beyond the table.
Hold head rotate it 45° to one side. Lower patient in supine position with head hanging.
Patient keep eye open focusing on the tip of your nose.
Return patient to starting position in smooth movement. Repeat on the other side.

Question 11

What do you assess in the Tilt test ?

Answer 11

Check for nystagmus or vertigo.
Left : assess left posterior and right anterior semicircular canals
Right : assess right posterior and left anterior semicircular canal

Question 12

Technique of the head impulse test HIT

Answer 12

Sit opposite to patient. Ask them to look at the tip of your nose. Hold patient head then rotate it 20° to the left/right then abruptly back to center.
Or do opposite.

Question 13

Result of the HIT

Answer 13

Test vestibular ocular reflex.
Positive test : eyes follow the turn then re fixate => peripheral cause.

Question 14

Abnormal ear shape ?

Answer 14

Abnormal alignment => disorder of mastoid / parotid gland
Cauliflower ears => trauma
Helix can develop hard nodules

Question 15

Otitis externa symptoms ?

Answer 15

Auricle tender to touch, red, moist, swollen auditory canal

Question 16

Otitis media symptoms ?

Answer 16

Red tympanic membrane : acute
- especially when eardrum bulging or disappearance of luminous cone

Retracted eardrum, white-yellowish : with effusion
- bubbles of air/fluid

Perforation of tympanic membrane : with discharge

Question 17

Peripheral nystagmus ?

Answer 17

Unidirectional, never purely vertical or torsional.
Visual fixation inhibit it.
Tinnitus and deafness often present.

Question 18

Central nystagmus ?

Answer 18

Bidirectional or unidirectional, can be purely horizontal, vertical or torsional.
Is not inhibited by visual fixation.
Associated with diplopia, hiccups, dysarthria

Question 19

Type of hearing loss ?

Answer 19

Sensorineural : understanding speech, noisy environment make it worse
CNN : Conductive hearing loss Needs Noisy environment

Question 20

Symptoms and pathology associated with earache and discharge

Answer 20

Fever, cough, sore throat, concurrent upper respiratory infection
- otitis externa / media depending on location of pain

Yellow-green discharge : acute otitis externa or acute / chronic otitis media with perforation

Question 21

What is tinnitus ?

Answer 21

Perceived sound that has no external stimuli. Common and increase with age.
Meniere disease : tinnitus, hearing loss, vertigo

Question 22

Type of dizziness ?

Answer 22

Vertigo : room spinning, tilting
Sense of passing out : presyncope
Sense of unsteadiness : disequilibrium

Question 23

What is vertigo and causes ?

Answer 23

Sensation of true rotational movement of patient and surrounding

Peripheral cause : BPPV, labyrinthitis, vestibular neuritis, Meniere disease
Central cause : (ataxie, diplopia, dysarthria) cerebral vascular disease, posterior fossa tumors, vestibular migraine

Question 24

SO STONED : questions of ear

Answer 24

Symptoms : vertigo, dizziness, instability, oscillopsia, headache
Occurrence : how often ?
Since : when did it start ?
Triggers : Head movement, stress
Otological : hearing loss, tinnitus
Neurological : loss of consciousness, paralysis, epilepsy
Evolution : of complaints
Duration : of episodes

Question 25

How do you know which ear it is based on the eardrum ?

Answer 25

Look at the cone of light.
In the right ear the cone of light is at 4-5 o’clock => right side of eardrum
In the left ear the cone of light is at 7-8 o’clock => left side of eardrum