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    ENT Ear Examination Script

    Uploaded by

    Vanessa Hermione
    The document outlines the steps for conducting an ear examination, including inspecting the pinna, ear canal, and tympanic membrane with an otoscope. Key examination findings are noted such as normal anatomy, otitis externa, otitis media, and perforated tympanic membrane. Tuning fork tests including Weber's and Rinne's are then described to assess hearing. Completing the cranial nerve examination and additional testing such as audiometry is recommended to fully evaluate the patient.

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    ENT Ear Examination Script

    Uploaded by

    Vanessa Hermione
    456 views2 pages
    The document outlines the steps for conducting an ear examination, including inspecting the pinna, ear canal, and tympanic membrane with an otoscope. Key examination findings are noted such as normal anatomy, otitis externa, otitis media, and perforated tympanic membrane. Tuning fork tests including Weber's and Rinne's are then described to assess hearing. Completing the cranial nerve examination and additional testing such as audiometry is recommended to fully evaluate the patient.

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    The document outlines the steps for conducting an ear examination, including inspecting the pinna, ear canal, and tympanic membrane with an otoscope. Key examination findings are noted such as normal anatomy, otitis externa, otitis media, and perforated tympanic membrane. Tuning fork tests including Weber's and Rinne's are then described to assess hearing. Completing the cranial nerve examination and additional testing such as audiometry is recommended to fully evaluate the patient.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    456 views2 pages

    ENT Ear Examination Script

    Uploaded by

    Vanessa Hermione
    The document outlines the steps for conducting an ear examination, including inspecting the pinna, ear canal, and tympanic membrane with an otoscope. Key examination findings are noted such as normal anatomy, otitis externa, otitis media, and perforated tympanic membrane. Tuning fork tests including Weber's and Rinne's are then described to assess hearing. Completing the cranial nerve examination and additional testing such as audiometry is recommended to fully evaluate the patient.

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    © All Rights Reserved
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    ENT Ear Examination Script

    1. On general inspection, the patient is alert and comfortable at rest. He does not look like he is
    in pain or distress.

    2. Ask the patient which ear is the better ear.

    3. Ask the patient if there is any pain in his ear, if there is any pain at any point in time during
    the examination please let me know and I will stop.

    4. On inspection of the ear, both ears are symmetrical and there is no gross swelling of the pinna
    or mastoid area. Looking posteriorly, there are also no scars or hearing aids present.
    Areas to comment on:
    - pinna: scars, quality of cartialge, active infections, compare symmetry on the other side
    - mastoid: (move the pinna forwards, asking about pain again)
    - preauricular area: look for pits, sinuses and fistulae
    - conchal bowl

    5. Now inspect the other ear and make a comparison.

    6. On palpation, there is no tenderness over the cartilaginous portion of the pinna, over the ear
    canal and over the mastoid area.

    7. Switch on otoscope, let the patient know you’ll be examining the ear, if there’s pain please let
    me know

    8. On examination with the otoscope


    Technique: Use the little finger of the hand holding the otoscope to brace against the cheek of
    the patient; this should stop any damage to the ear if the patient makes any sudden movement.
    Be gentle with the otoscope. Make sure when you are moving it around in the EAC that your
    movements are slow and considered normal. Otherwise, you will cause the patient pain.

    Areas to comment:
    - EAC: to look for discharge, bony swellings
    - Pars tensa: perforations, retraction pockets, ossicles – particularly the laterlal process of
    the malleus and long process of the incus, presence of grommets
    - Pars flaccida: attic retraction pockets, cholesteatoma

    • Normal: Both tympanic membrane are intact. The external auditory canal is clear/has
    some cerumen impaction and there is no fluid in the middle ear cavity.

    • OME: Both tympanic membrane are intact. The external auditory canal is clear/has some
    cerumen impaction. There is notable yellowish fluid in the middle ear cavity. Perform the
    Valsalva maneuver to look for bubbling if fluid is present.

    • Otomycosis: Both tympanic membrane are intact. There is notably whitish discharge in
    the external auditory canal.

    • Perforated TM: The tympanic membrane in the right ear is perforated, and the hole takes
    up about __% of the TM.
    Next, explain to the patient that you are going to perform some tests using tuning forks to assess their
    hearing.
    Weber’s and Rinne’s Test

    Weber’s
    1. Strike a 512Hz tuning fork on my knee and place it in the midline forehead.

    2. Ask the patient if they heard it loudest in the right, left (lateralises – Weber’s +ve) or the centre
    (Weber’s –ve).

    Rinne’s
    3. Strike a 512Hz tuning fork on my knee and place it on the mastoid process to test BC

    4. Then place it beisde the pinna to test AC

    5. If AC > BC, Rinne’s positive (which is normal)

    Interpretation of results:
    - Weber’s positive: CHL on ipsilateral side or SNHL on contralateral side
    - Rinne’s positive: SNHL on that side
    - Right-sided severe SNHL or dead right ear 
    Weber’s positive on L, Rinner’s negative on R

    To complete this examination, I would like to examine all cranial nerves. Any facial nerve weakness
    should be graded on the House-Brackmann scale (I – VI). I would also like to do a rigid nasoendoscopy
    to examine the posterior nasal space esp. ghe opening of the Eustachian tubes where NPCs can arise. I
    would also like to send the patient for formal audiological assessments with a Pure Tone Audiometry to
    look for patterns of hearing loss that correspond with the clincial findings.

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