![]() The nose can be inspected from the front to examine the anterior nares by lifting the tip of the nose up and looking inside without a speculum. Obvious bend or deformity: a deviated nose is often best looked at from above.Look at the nose from the front and side for any signs of the following: Seasonal or daily variation in symptoms.įirst look at the external nose.Snoring (associated with nasal obstruction).Common symptoms of nasal disease include: It includes looking into the mouth and pharynx. Free field voice testing (whisper from 40 cm).įull nose examinations assess the function, airway resistance and occasionally sense of smell.If there is a negative Rinne's test with hearing loss, then the problem is a conductive one. If the Rinne's test is positive and there is hearing impairment, it is a sensorineural and not a conductive problem. Normally, the patient should hear the air conduction better than the bone conduction (ie first position better than the second). The patient is asked to report on which of the two positions was the louder. Then immediately transfer it to the mastoid process and hold it firmly there (applying counter pressure to the opposite side of the head) for two seconds. Rinne's test - strike a tuning fork and hold it vertically with its nearest prong about 1 cm away from the patient's external auditory meatus, making sure that it is not touching any hair.If the sound is louder in the better ear, it is more likely to be a sensorineural hearing loss. If the patient has unilateral hearing loss and the sound is louder in the weaker ear, this suggests a conductive hearing loss. In a patient with normal hearing, the tone is heard centrally. The vibrating fork is placed in the middle of the forehead and the patient is asked whether any sound is heard and, if so, whether it is equally heard in both ears or not. Weber 's test - this is performed in conjunction with Rinne's test.Tuning fork tests: Weber's test and Rinne's test :.Haemotympanum (blood in the middle ear).Ĭheck facial nerve function if ear pathology is serious.ĭetailed hearing tests are usually performed in audiology clinics.Ī patient with normal hearing should hear equally as well in both ears.Perforations (note size, site and position).Occasionally, in a healthy, thin drum, it is possible to see the following:Ĭommon pathological conditions related to the ear include: In a normal drum the following structures can be identified: ![]() The drum is roughly circular (~1 cm in diameter). Move the otoscope in order to see several different views of the drum it is not always possible to see the whole drum in one single view using an otoscope. The drum should move on squeezing the balloon. The mobility of the eardrum can be evaluated using a pneumatic speculum, which attaches to the otoscope. ![]() Note the condition of the canal skin, and the presence of wax, foreign tissue, or discharge. ![]() It is necessary to fit the correct size of speculum to achieve the best view it is tempting to use a small piece for ease of insertion, but this simply restricts the image available. Modern otoscopes are designed to use a disposable speculum. Hold the otoscope near to the eyepiece rather than at the end this helps to reduce the patient's discomfort due to hand movements, which are exaggerated in the ear. (In infants, only pull the pinna posteriorly not superiorly for examination.) ![]() The examination technique involves grasping the pinna and pulling it up and backwards (posteriorly and superiorly), which helps to straighten the ear canal and for inspection of the TM. Batteries need to be fully operational to allow optimal light during examination. An otoscope also has its own magnification, which gives a good view of the tympanic membrane (TM). A modern electric otoscope/auriscope with its own light source is primarily used to examine the ear. ![]()
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