M10.05.06 Examination of the Ears

The examination of the ears is a critical component of a comprehensive head and neck assessment. This section provides an overview of the techniques and methodologies used to examine the ears, essential for diagnosing ear-related conditions and ensuring effective patient care.

Clinical Anatomy of the Ear

• External Ear: Comprises the auricle (pinna) and external auditory canal.
• Middle Ear: Contains the tympanic membrane (eardrum), ossicles (malleus, incus, stapes), and the Eustachian tube.
• Inner Ear: Includes the cochlea, vestibule, and semicircular canals, essential for hearing and balance.

Common Complaints of the Ear

• Hearing loss
• Ear pain (otalgia)
• Tinnitus (ringing in the ears)
• Discharge (otorrhea)
• Vertigo (dizziness)

History Taking in Ear Examination

1. Chief Complaint: Identify the primary issue (e.g., hearing loss, pain, discharge).
2. History of Present Illness: Duration, onset, progression, and associated symptoms.
3. Past Medical History: Previous ear infections, surgeries, or trauma.
4. Family History: Genetic predispositions to ear conditions.
5. Social History: Exposure to loud noises, use of ear protection, and swimming habits.
6. Review of Systems: Check for related symptoms such as nasal congestion or sore throat.

Examination Techniques

1. Inspection:
   • External Ear: Look for abnormalities in shape, size, or lesions.
   • External Auditory Canal: Check for discharge, swelling, or foreign bodies.
2. Palpation:
   • Auricle and Tragus: Check for tenderness indicating possible infection.
   • Mastoid Process: Palpate for tenderness suggesting mastoiditis.
3. Otoscopic Examination:
   • Procedure:
     • Use an otoscope to visualize the ear canal and tympanic membrane.
     • Gently pull the auricle upward and backward to straighten the canal.
   • Findings:
     • Normal tympanic membrane: Pearly gray, translucent, with a visible cone of light.
     • Abnormal findings: Redness, bulging, retraction, perforation, or presence of fluid.
4. Hearing Tests:
   • Whisper Test: Assess gross hearing by whispering and asking the patient to repeat words.
   • Tuning Fork Tests:
     • Rinne Test: Compares air conduction to bone conduction.
     • Weber Test: Assesses lateralization of sound.

Key Points to Remember

• Always inspect and palpate both ears.
• Use proper otoscope technique to avoid discomfort and ensure clear visualization.
• Document findings thoroughly, noting any abnormalities.
• Conduct hearing tests to assess auditory function comprehensively.

Related Abnormal Conditions

• Otitis Externa: Inflammation of the external auditory canal.
• Otitis Media: Infection or inflammation of the middle ear.
• Tympanic Membrane Perforation: A hole or tear in the eardrum.
• Cholesteatoma: Abnormal skin growth in the middle ear.
• Mastoiditis: Infection of the mastoid bone.
• Cerumen Impaction: Accumulation of earwax causing blockage.

Tables

Bibliography

1. Dhingra, P. L., & Dhingra, S. (2013). Diseases of Ear, Nose and Throat & Head and Neck Surgery. Elsevier Health Sciences.
2. Kanski, J. J., & Bowling, B. (2016). Clinical Ophthalmology: A Systematic Approach. Elsevier Health Sciences.
3. Papadakis, M. A., McPhee, S. J., & Rabow, M. W. (2018). Current Medical Diagnosis and Treatment. McGraw-Hill Education.
4. Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2018). Mosby’s Guide to Physical Examination. Elsevier.