Examination of the Ear
Examination of the ear deals primarily with whether the patient is able to hear. There are several tests that may be used to test hearing.
Whispered Voice Test:-. The patient's response to the examiner's whispered voice can be used to determine hearing ability. The examiner masks the hearing in one of the patient's ears by placing a finger gently in the patient's ear canal. Standing approximately 30 to 60 cm (12 to 24 inches) away from the patient, the examiner whispers one- or two-syllable words very softly and asks the patient to repeat the words heard. If the patient has difficulty, the examiner gradually increases the loudness of the whisper until the patient responds appropriately. The procedure is repeated in the other ear. The patient should be able to hear softly whispered words in each ear at a distance of 30 to 60 cm (12 to 24 inches) and respond correctly at least 50% of the time.
Ticking Watch Test.:-
- The ticking watch test uses a nonelectric ticking watch to test high-frequency hearing. The examiner positions the watch approximately 15 cm (6 inches) from the ear to be tested, slowly moving it toward the ear. The patient is asked to tell the examiner when the ticking is heard. The distance can be measured and will give some idea of the patient's ability to hear high-frequency sound. 18,19 Weber Test. The examiner places the base of a vibrating tuning fork on the midline vertex of the patient's head. The patient is asked if the sound is heard equally well in both ears or is heard better in one ear (lateralization of sound). The patient should hear the sound equally well in both ears (Figs. 2-51 and 2-52). If the sound is lateralized, the patient is asked to identifY through which ear the sound is heard better. To test the reliability of the patient's response, the examiner repeats the procedure while occluding one ear with a finger and asks the patient through which ear the sound is heard better. It should be heard better in the occluded ear. 18,19
Rinne Test.:- The Rinne test is performed by placing the base of the vibrating tuning fork against the patient's mastoid bone. The examiner counts or times the interval with a watch. The patient is asked to tell the examiner when the sound is no longer heard, and the examiner notes the number of seconds. The examiner then quickly positions a still-vibrating tine 1 to 2 cm (0.5 to 0.8 inch) from the auditory canal, and the patient is asked to tell the examiner when the sound is no longer heard. The examiner then compares the number of seconds the sound was heard by bone conduction and by air conduction. The counting or timing of the interval between the two sounds determines the length of time that sound is heard by air conduction. Air-conducted sound should be heard twice as long as bone-conducted sound. For example, if bone conduction is heard for 15 seconds, the air conduction should be heard for 30 seconds.
Schwabach Test. This test is a comparison of the patient's and examiner's hearing by bone conduction. The examiner alternately places the vibrating tuning fork against the patient's mastoid process and against the examiner's mastoid bone until one of them no longer hears a sound. The examiner and patient should hear the sound for equal amounts of time.
Conductive hearing loss:- implies that the patient experiences reduction of all sounds rather than difficulty in interpreting sounds. Sensorineural or perceptual hearing loss indicates that the patient has difficulty interpreting the sounds heard. Internal examination of the ear may be accomplished with the use of an otoscope, if available. In this case, the examiner would observe the canal as well as the eardrum (tympanic membrane), noting any blockage, excessive wax, swelling, redness, transparency (usually pearly gray), bulging, retraction, or perforation of the eardrum.