Free field hearing tests: Whisper “44BW” voice at 2ft
with tragal rubbing the opposite ear→If no response try at
6in→louder at 2ft→louder at 6in. Test aborted if 50% answers
correct
Pick up auroscope & attach speculum
Ask pt if they have a better ear & examine. Inspect with the
light the pinna (external ear) & surrounding skin: pre-auricular
sinuses, endaural & postauricular incisions (groove btw back of ear
& skull
Insert auroscope looking at skin for infection. If the posterior
canal looks defective then probably pt has had mastoid operation
(common in exams) (due to chronic infx or cholesteatoma - a benign
destructive tumour)
Look for light reflex in tympanic membrane antero-inferiorly,
& look at pars flaccida (at top of of tympanic membrane) to see if
it is retracted or debris full
Examine opposite ear
Tuning fork tests
Rinne's (conductive loss): tap fork & put it in front of
ear. Rinne +ve (normal) is if air is louder. -ve (abn) w conduction
problems. (A false -ve may occur if dead ear, & sound perceived in
other ear.)
Weber's: strike fork & place on forehead. The pt will
perceive sound louder in ear with worse conductive component. So with
conductive loss heard “towards the bad hearing ear.” With
sensory loss heard “towards good hearing ear.” Can remember
this by trying on self with finger in ear.
“I would like to perform clear tone audiometry & evoked rsponse audiometry”
