examination of ear

8/7/2019 EXAMINATION OF EAR

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EXAMINATION OFEAR



EXAMINATION OF EARPINNA, PREAURICULAR, POST AURICULAR

REGIONEXTERNAL AUDITORY MEATUS,

TYMPANIC MEMBRANE,MIDDLE EAR,TESTS FOR THE FUNCTION OF EUSTACHIAN

TUBE,TESTS OF HEARING,

TESTS OF BALANCE,EYES.CRANIAL NERVES



EXAMINATION OF THE PINNA:

SHAPE

SIZESYMMETRYSIGNS OFINFLAMMATION

ULCERSSCARS



P RE AURICULAR REGION



P OST AURICULAR REGION



EXAMINATION OF THE EXTERNALAUDITORY MEATUS :

PATENCY:ATRESIA, STENOSIS

SWELLING:

INFLAMMATORY,NEOPLASTIC.DISCHARGE:

WAX, MUCOID,PURULENT,HAEMORRHAGIC,

WATERY.TRAGAL TENDERNESS.SAGGING OF THEPOSTERO-SUPERIORMEATAL WALL.



TYMPANIC MEMBRANE:

(USING NAKED EYE, OTOSCOPE, )POSITION,COLOUR:

HEMORRHAGEDULLNESSBLUEBULLAE

OSSICLESPERFORATIONS:

MARGINAL AND CENTRALSITESIZE

MOBILITY:(RETRACTIONS) BY USING A

PNEUMATIC OTOSCOPE, ORSIEGLE'S SPECULUM.



MIDDLE EAR:

CAN BE EXAMINEDTHROUGH APERFORATION.LOOK AT THE COLOROF MUCOSA, EDEMA,DISCHARGE,POLYPS,PROMONTORY.



TESTS FOR EUSTACHIAN TUBEFUNCTIONS

QUALITATIVE METHODS:VALSALVA MANEUVER:

P RINCI P LE: DEMONSTRATION OFTUBAL PATENCY WITHOUTEXTERNAL AIDS.METHOD:

AFTER TAKING A DEEP BREATHTHE PATIENT PINCHES HIS NOSE ANDCLOSES HIS MOUTH IN AN ATTEMPTTO BLOW AIR IN HIS EARS.OTOSCOPY SHOWS MOVEMENT OFTHE DRUM. NOTE: FAILURE OF THISTEST DOES NOT PROVE PATHOLOGICOCCLUSION OF THE TUBE.

THIS MANEUVER IN THEPRESENCE OF NASAL ANDNASOPHARYNGEAL INFECTIONCARRIES THE DANGER OFTRANSMISSION OF INFECTION TOTHE EAR.



TESTS FOR EUSTACHIAN TUBEFUNCTIONS

TOYNBEE'S TEST:PRINCIPL E:

IT IS SAFER AND CONFIRMS NORMALTUBAL FUNCTION.

METHOD:

THE NOSE IS CLOSED AND THEPATIENT SWALLOWS.THERE IS IN DRAWING OF THETYMPANIC MEMBRANE, CONFIRMED BYOTOSCOPY

FRENZEL TEST:PRINCIPL E:

THE AIR IN THE NASO PHARYNX ISCOMPRESSED BY THE MUSCLE OFFLOOR OF MOUTH AND TOUNGEINCREASING PRESSURE IN THENASOPHARYNX WHICH OPENS THETUBE.



TESTS FOR EUSTACHIAN TUBE FUNCTIONSQUA N T I T A T IV E METHODS:

TYMPANOMETRY.



TESTS OF BALANCE

ROMBERG TESTMETHOD:

- PATIENT STANDS UPRIGHT WITH THE FEET PARALLELAND CLOSE TOGETHER, EYES CLOSED ,AND THE ARMS

FOLDED IN FRONT OF THE CHEST OR OUTSTRETCHED.BLINDFOLD GAIT AND WALKING A STRAIGHT LINE.RESULTS:

CENTRAL LESIONS GIVE IRREGULAR PATTERN OF SWAY.UNILATERAL PERIPHERAL LESION OR A UNILATERALCEREBELLAR LESION, THE PATIENT TENDS TO SWAYTOWARDS THE AFFECTED SIDE.THE PATIENT DEVIATES TOWARDS THE SIDE OF THELESION, IN GROSS LESIONS.QUANTITATIVE ASSESSMENT MAY BE CARRIED OUT USINGA BALANCE PLATFORM.



UNTERBERGER'S STE PP ING TEST

METHOD:STEPPING ON ONE SPOT WITH THE EYES

CLOSED.RESULT:

PERIPHERAL LESIONS- ROTATION OF THE BODYAXIS TO THE SIDE OF THE LABYRINTHINELESION.CENTRAL DISORDERS- THE DEVIATION ISIRREGULAR.DEVIATIONS OF GREATER THAN 40 DEGREE ARESIGNIFICANT.



FINGER-NOSE P OINTING TEST:

M ETHOD:

THE INDEX FINGER OF THE OUTSTRETCHEDHAND IS BROUGHT TO THE POINT O THE NOSE

WITH THE EYES CLOSED.R ESULT

ATAXIA AND DISORDERS OF COORDINATIONINDICATE AN IPSILATERAL CEREBELLAR LESIONOR A DISORDER OF POSITIONAL SENSE.



TESTS FOR EYE MOVEMENTS:OCULAR MOVEMENTS ± ALL DIRECTION OF GAZE

NYSTAGMUSNYSTAGMUS SHOULD BE SOUGHT WITH THE HEAD IN THE :

PRIMARY POSITION.WHEN FLEXED, EXTENDED, LATERALLY INCLINED AND ROTATED.THESE CONSTITUTE THE CERVICAL POSTURAL TESTS (BARANYHALPIKE).

METHOD: ( WITH THE HEAD IN NEUTRAL POSITION)PATIENT LOOKING TO THE FRONT.OBSERVER VIEWING FROM THE SIDE.VISUAL FIXATION IS OBTAINED BY PLACING A FINGER CENTRAL TOTHE EYES AND AT LEAST 45 CM FROM THE NOSE.

THE PRESENCE OR ABSENCE OF NYSTAGMUS IS NOTED, AND THENTHE FINGER IS MOVED 30° TO EITHER SIDE ASKING THE PATIENT TOFOLLOW THE FINGER WITHOUT MOVING THE HEAD.OBSERVATION WITH AND WITHOUT FRENZEL'S GLASSES.EXAMINED IN A DARK ROOM WITH + 15 DIOPTER LENSES WHICHALMOST COMPLETELY SUPPRESS OPTICAL FIXATION.EXAMINE WITH AND WITHOUT FIXATION FOR A FIXATION NYSTAGMUS.



STATICVESTIBULAR BALANCE ± NYSTAGMUS :

CHECK DIRECTIONCHECK FOR TORSIONAL COMPONENTCHECK FOR GAZE SUPPRESSION

Pendular Jerk



P OSITIONAL TESTING( DIX - HAL P IKE METHOD).

PRINCIPLE:SCREENING TEST FORPOSITIONAL NYSTAGMUS.

METHOD:(WITH THE HEAD IN DIFFERENT

POSITIONS).THE HEAD IS FIRMLY GRASPEDWITH THE PATIENT SITTING ON ACOUCH.THE PATIENTS HEAD IS ROTATED45 TO ONE SIDE AND THEN THEOTHER WHILE HE IS MADE TOASSUME THE SUPINE POSITIONWITH THE HEAD HANGING 30BELOW THE EDGE OF THE TABLE.THE HEAD IS KEPT IN THISPOSITION FOR SOME TIME.THE EYES SHOULD BE OBSERVED

FOR NYSTAGMUS.



CALORIC TESTING:PRINCIPLE:

THE LSCC IS BROUGHT INTO A VERTICAL POSITION IN THE SUPINEPATIENT BY ELEVATING THE HEAD 30° .THE VOLUME OF ENDOLYMPH IS CHANGED BY COOLING ORWARMING THE LABYRINTHINE CAPSULE BY IRRIGATION WITH WATERAT 30° AND 44° C FOR 30-40 SEC.THIS PRODUCE CHANGES IN VOLUME OF THE ENDOLYMPH(PREVIOUS CONCEPT WAS OF CURRENTS) WHICH DEFLECTS THECUPULA.IN CASES WHERE TYMPANIC MEMBRANE IS PERFORATED AIR

CALORIC TEST IS CARRIED OUT.RESULT:

REDUCED EXCITABILITY; PARTIAL LOSS OF FUNCTIONTOTAL ABSENCE OF EXCITABILITY; COMPLETE LOSS OF FUNCTION.DIRECTIONAL PREPONDERANCE; INDICATES A DIFFERENCE IN

SPONTANEOUS ACTIVITY IN THE HIGHER VESTIBULAR CENTERS.ADVANTAGE:

EACH LABYRINTH CAN BE EXAMINED SEPARATELY.



FISTULA TEST

PRINCIPLE:IN THE PRESENCE OF A

FISTULA IN THE LSCC, ORSTAPES OR ELSEWHERE INTHE LABYRINTHINE CAPSULECAUSED BY TRAUMA,CHOLESTEATOMA, OR LYTICPROCESS, A SUDDENINCREASE IN PRESSURE INTHE EAM PRODUCES VERTIGO,NYSTAGMUS.THE SAME SYMPTOM CAN

OCCUR IN CASE OFADHESIONS BETWEEN THEMEMBRANOUS LABYRINTH ANDTHE STAPES FOOTPLATE.(FISTULA TEST WITHOUT AFISTULA).



CONVENTIONAL VOICE AND FORCEDWIS P HER

THIS REQUIRES A QUIET ROOM OF ABOUT 6 M LONG

ECHOES WHICH FALSIFY THE RESULTS.EACH EAR IS TESTED SEPARATELY.

THE BETTER EAR IS TESTED FIRST.THE OPPOSITE EAR IS MASKED BY PLACING A

SHEET OF PAPER OVER THE EAC AND SCRATCHING

OVER THE PAPER TO PRODUCE MASKING NOISE (VIBRATION METHOD OF MASKING).IN CASES OF SEVERE UNILATERAL DEAFNESS

BARANY'S NOISE BOX HAS TO BE USED.

TESTS OF HEARING:



TUNING FORK TESTS:(FORK OF 512 HZ IS USED).

RINNE'S TEST:PRINCIPL E:

THIS TEST BASED ON MONAURALCOMPARISON OF AC WITH BC

METHOD:

THE PATIENT CAN BE TESTED IN TWOWAYS

DURATION,INTENSITY.

THE PATIENT IS ASKED WHETHER THETUNING FORK PLACED IN FRONT OF THEEAR OR BEHIND THE EAR ON THE MASTOIDIS HEARD BETTER.

R ES U L TS:

IF AC> BC, RINNE'S TEST IS POSITIVE.NORMAL EARSENSORINEURAL DEAFNESS .

IF BC> AC, RINNE'S TEST IS NEGATIVE.CONDUCTIVE DEAFNESS.



WEBER'S TEST:

PRI NC IP LE:

IT IS DEPENDENT ON BINAURALCOMPARISON OF BONECONDUCTION.

METHOD:

THE TUNING FORK IS PLACED INTHE CENTER OF SKULL AT THEHAIRLINE.THE PATIENT WITH NORMAL

HEARING WILL HEAR EQUALLY INBOTH EARS.THE PATIENT WITH A UNILATERAL

CONDUCTIVE HEARING LOSSLOCALIZES THE TONE IN THEDISEASED EAR.THE PATIENT WITH A UNILATERAL

SENSORINEURAL LOSS WILLLOCALIZE TO THE HEALTHY EAR.



SCHWABACH'S TEST:

DEPENDS ON COMPARISONOF THE BONE CONDUCTIONOF THE PATIENT WITH THATOF THE EXAMINER.

examination of ear

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