Examination Of The Ear

HISTORY TAKING:

Ear discharge:

Left / Right / Both

Intermittent/Continuous

Profuse / Scanty

Mucoid / Mucopurulent / Blood tinged

Foul smelling / Non foul smelling

Associated with URTI Duration:

Hearing loss:      Left/Right/Both

Onset – Sudden/Insidious

Progressive/Nonprogressive

Degree of deafness

Relation to noisy surroundings   Duration:

 

Earache:  Left/Right/Both

Radiation/Nonradiation

Aggravated on chewing     Duration:

 

Tinnitus:    Left/Right/Both

Type – Pulsatile/Hissing/

High pitched/Low pitched

Associated with deafness    Duration:

 

Dizziness:  Duration of attack

Onset – Sudden/insidious/Episodic

Associated with nausea or vomiting

Aggravated by change of posture/ Turning to side- Left/Right,/Bending head

Associated with hearing loss/tinnitus/ear discharge        

 

Facial weakness: Left/Right/Both

Onset – Sudden/Insidious

Associated drooling saliva/ inability to close the eye/accumulation of food in one side of the cheek Duration:

 

Other symptoms:  Itching

Aural fullness

Headache

Swelling of the ear

Swelling/discharge in front or behind the ear

Trauma to the ear/Bleeding from the ear            

 

History suggestive of complication:  Fever

Headache

Nausea, Vomiting

Diplopia, Blurring of vision

Facial weakness

 

PAST HISTORY:  Ear disease

Otological surgeries

Diabetes mellitus

Exanthematous fever

Tuberculosis

Ototoxic drugs

Noise exposure

Trauma to head or ear

 

FAMILY HISTORY: Deafness

Tuberculosis

 

PERSONAL HISTORY:  Dip bath

Swimming in the pool

Ear manipulation

Smoking

Allergies

 

External appearance:RIGHT   LEFT

 

Preauricular area-   Skin tags

Swelling

Sinuses

Discharge

Tragal tenderness

Temporomandibular joint

– Tenderness present/absent

Pinna-   Skin over the pinna (signs of inflammation)

Swelling

Tenderness

Trauma

Post-auricular area-   Scar

Fullness of post-aural sulcus

Swelling

Discharge

Sinuses

Mastoid tenderness

Odema over mastoid (Battle's sign)

External auditory canal- Wax/Keratosis

Foreign body

Skin excoriation

Fungal debris

Discharge- scanty/profuse

Mucoid/Mucopurulent

Blood stained

Foul smelling

Granulations

Swelling

Tympanic membrane -  Colour

Cone of light

Mobility (Sieglisation/Valsalva's manoeuvre)

Eustachian tube patency-

Valsalva's/Toynbee's/Frenzel

Tympanosclerotic patches

Bulging of the tympanic membrane- Pars tensa/Pars flacida

Retraction (Grade I – IV)

Cholesteatoma

Perforation-Pars tensa/Pars flacida/Attic

Size

Shape

Middle ear structures visible thr' perforation –

Foreshortening of handle of Malleus

Incudostapedial joint

Status of middle ear mucosa-

Edematous/Normal

Visible round window niche

Oval window

Eustachian tube opening

 

Tunning fork tests:          RIGHT   LEFT

Rinne's (256 Hz)

(512 Hz)

(1024 Hz)            

 

Weber's

ABC

Gelle's test        

 

Facial Nerve      

Fistula sign         

 

ASSESMENT OF VESTIBULAR FUNCTIONS

Static testing:    

 

Romberg test

Tandem walking

Unterberger's test         

Nystagmus:       

 

Spontaneous nystagmus- I/II/III degree

Induced nystagmus-

Dix Hallpike's Manoeuvre

Fistula test

Caloric test- Fitzgerald Hallpike's

Modified Kobrak's test

Tullio's phenomenon

Pendulum tracking

Optokinetic drum

Barany's rotation test    

Cerebellar function tests:            

 

Dysmetria and past pointing

Asynergia

Dysdiadochokinesis

Rebound

Romberg's test

Tandem walking

Finger nose test

Finger-finger test            

Examination of eyes:     

 

Pupil reaction

Ocular movements

Corneal reflex

Fundal examination       

Examination of cranial nerves:  

 

IX-X Nerve –  PMovements of the soft palate

Gag reflex          

XI Nerve-  Shrugging of shoulders

Tension in the contra lateral SCM            

XII Nerve-  Tongue movements/Fasciculation's/Fibrillations

Wasting

Taste sensations             

CLINICAL IMPRESSION:

 

INVESTIGATIONS

Puretone Audiogram:   

Impedence measurements:  Tympanometry

Stapedius reflex

Speech Audiometry:     

Tests of recruitment:     Fowler's test: Alternate Binaural loudness balance test

Loudness discomfort level

Tone decay test:             

Auditory evoked potential:   BERA

EEG

Electrocochleography

Otoacoustic emissions

Radiological evaluation 

X Ray Perorbital view:

 

CT Scan:

MRI:

Routine blood investigations:

Histopathological examination:

Other investigations:

SURGERY PLANNED:

SURGERY EXECUTED:

INTRA OPERATIVE FINDINGS:

 

POST OPERATIVE PERIOD/COMPLICATIONS:

COURSE OF STAY IN THE HOSPITAL:

ADVICE:

FOLLOW UP:

 

POST OPERATIVE AUDIOLOGICAL EVALUATION:

At 3 Weeks:

At 3 Months:

At 6 Months: