Otoscopy and tuning fork tests Flashcards
What is otoscopy?
The examination of the pinna, ear canal and tympanic membrane through the use of an otoscopy
What is the purpose of otoscopy?
To ensure that the ear canals are free of any obvious obstructions that would hinder further audiological testing or intervention
Why is it important to look for signs of surgical scarring during otoscopy?
This may affect how you take an impression for a hearing aid
How do you prepare the patient before otoscopy?
-Ask if the patient has any ear-related symptoms such as discomfort, pain or ear discharge, is currently being treated for any ear-related problems or has previously has surgery involving their ears
-Explain procedure to the patient and tell them to report any pain or discomfort they fell
-Obtain verbal informed consent
-Start with the ear least likely to have any abnormalities
What is the onward referral criteria for otoscopy?
- Complete or partial obstruction of the external auditory canal
- Abnormal appearance of the outer ear and/ or the eardrum
What is the safest position to do otoscopy in?
-Patient and audiologist seated
-Otoscopy braced securely against the patient’s head by the examiner’s pinky finger
-Manipulation of pinna appropriate
What are signs of a healthy tympanic membrane?
-Light reflex (cone of light) at 7 o’clock in the left ear and 5 o’clock in the right ear
-Pearly grey in colour, shiny and translucent
-No bulging or retraction
-Smooth in consistency
-Short process, malleus and umbo visible
-Intact with no lesions, blood or holes
Describe this otoscopy result
Normal otoscopy in both left and right ear
Describe this otoscopy result
Occluding ear wax (cerumen) in both left and right ear
Describe this otoscopy result
Schwartz sign (characteristically reddish discoloration) in both right and left ear- sign of otosclerosis
Describe this otoscopy result
-Tympanic membrane perforation in both the left and right ear
-In the right ear the edges are quite smooth- suggests it could have been there a while
-No active infection
Describe this otoscopy result
Normal for both right and left ear
Describe this otoscopy result
Normal right ear, glomus tumour in the left ear
Describe this otoscopy result
Normal right ear, potential fluid build up in the left ear suggests otitis media with effusion
Describe this otoscopy result
Normal right ear, no otoscopy could be carried out in the left ear due to abnormal ear canal and external ear (caused by radical mastoidectomy)
What are tuning fork tests?
-Tuning forks provide very basic information about the probable presence or absence of a significant conductive element to the hearing loss
According to the BSA recommended procedure what frequency should the tuning fork elicit and why?
-516 Hz
-At this frequency the tone does not fade too quickly, produces limited overtones and is not vibrotactile (you can’t feel the vibration without the sound)
What is the correct method for striking the tuning fork?
-The tuning fork must include a footplate and there should be no damage or chips to the tines
-Hold the tuning fork by its stem and strike one side of the tines, two thirds along the tine from the base on a padded surface, your elbow or ball of hand
What are the names of the two tuning fork tests?
The Weber Test and The Rinne Test
What is the procedure for the Weber test?
- Strike the tuning fork and place it on the patient’s midline
- Place the other hand gently on the patient’s head to ensure enough counter-pressure is applied
- Hold in place for 4 seconds
- Ask the patient where the tone is heard (both ears, centrally in the head, or towards the left or right)
For the Weber test, what can be interpreted if the patient hears the tone:
1. Centrally
2. In one ear
- Symmetrical hearing or symmetrical hearing loss
- Asymmetrical sensorineural hearing loss (sound heard in the better ear), asymmetrical conductive hearing loss (sound heard in the poorer ear)
What is the procedure for the Rinne test?
- Start with the ear which the Weber has lateralised to (if appropriate)
- Strike the tuning fork and hold the tines approximately 25mm from the ear canal entrance in position for 2 seconds
- Press the footplate firmly against the mastoid
- Place your other hand on the opposite side of the patient’s head to ensure enough counter-pressure is applied
- Hold the tuning fork in place for another 2 seconds
- Ask the patient whether the tone is louder next to the ear or behind the ear
What can be interpreted from the Rinne test if the patient hears the tone louder:
1. Next to the ear canal
2. Behind the ear
- Air conduction is better- indicates either normal hearing or a sensorineural hearing loss (Rinne positive result)
- Bone conduction is better- indicates a significant conductive element to the hearing loss (Rinne negative result)
What are the problems with the Weber test?
-The Weber test can determine a difference of 5dB between the ears in terms of bone conduction thresholds
-This test is complicated by the presence of a unilateral or asymmetrical conductive hearing loss (the tone will able to be heard on the conductive side or the side with the greater conductive loss)
-Therefore it is prone to error
