Diagnostic Tests for Ear infection
Ear infection Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Ear infection:
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- Ear Infections: Home Testing:
Ear infection Diagnosis: Book Excerpts
Diagnostic Tests for Ear infection: Online Medical Books
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EARACHE:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
It should go without saying that diagnosis begins with an adequate otoscopic examination. If the drum is obscured by wax, gentle lavage after using Cerumenex will usually clear the canal. If there is an exudate, a culture and sensitivity should be ordered. Perhaps a throat culture should be done also. X-rays of the mastoids and petrous bones should be done if the exudate is believed to be from a deeper source. Perhaps a CT scan is also needed. If there is hearing loss, an audiogram needs to be done and a tympanogram will be useful in diagnosing serous otitis media. A trial of carbamazepine (Tegretol®) or phenytoin (Dilantin®) may be useful in diagnosing glossopharyngeal neuralgia or tic douloureux. If the discharge is thought to be cerebrospinal fluid, a CT scan and RISA study should be done.
Referral to an ear, nose, and throat specialist or neurologist should be considered before ordering expensive diagnostic tests.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
EAR DISCHARGE:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
The most important test to do is a smear, culture, and sensitivity of the discharge. If there is fever, a CBC, sedimentation rate, and chemistry panel should be done. The ears should be examined after thorough irrigation. X-rays of the mastoids and petrous bones should be done if a deep source for the discharge is suspected. Audiograms are helpful if there is hearing loss. If the discharge is thought to be cerebrospinal fluid, a RISA study and CT scan of the brain may need to be done. An ear, nose, and throat specialist should be consulted before ordering expensive diagnostic tests.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Earache:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Ask the patient to characterize his earache. How long has he had it? Is it intermittent or continuous? Is it painful or slightly annoying? Can he localize the site of ear pain? Does he have pain in other areas such as the jaw? Does he experience any associated hearing loss?
Ask about recent ear injury or other trauma. Does swimming or showering trigger ear discomfort? Is discomfort associated with itching? If so, find out where the itching is most intense and when it began. Ask about ear drainage and, if present, have the patient characterize it. Does he hear ringing, “swishing,” or other noise in his ears? Ask about dizziness or vertigo. Does it worsen when the patient changes position? Does he have difficulty swallowing, hoarseness, neck pain, or pain when he opens his mouth?
Find out if the patient has recently had a head cold or problems with his eyes, mouth, teeth, jaws, sinuses, or throat. Disorders in these areas may refer pain to the ear along the cranial nerves.
Find out if the patient has flown, been to a high-altitude location, or been scuba diving.
Begin your physical examination by inspecting the external ear for redness, drainage, swelling, or deformity. Then apply pressure to the mastoid process and tragus to elicit tenderness. Using an otoscope, examine the external auditory canal for lesions, bleeding or discharge, impacted cerumen, foreign bodies, tenderness, or swelling. Examine the tympanic membrane: Is it intact? Is it pearly gray (normal)? Look for tympanic membrane landmarks: the cone of light, umbo, pars tensa, and the handle and short process of the malleus. (See Using an otoscope correctly.)
Perform the watch tick, whispered voice, Rinne, and Weber's tests to assess for hearing loss.
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Source: Handbook of Signs & Symptoms (Third Edition), 2006
Hearing loss:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient reports hearing loss, ask him to describe it. Is it unilateral or bilateral? Continuous or intermittent? Ask about a family history of hearing loss. Then obtain the patient’s medical history, noting chronic ear infections, ear surgery, and ear or head trauma. Has the patient recently had an upper respiratory tract infection? After taking a drug history, have the patient describe his occupation and work environment.
Next, explore associated signs and symptoms. Does the patient have ear pain? If so, is it unilateral or bilateral, or continuous or intermittent? Ask the patient if he has noticed discharge from one or both ears. If so, have him describe its color and consistency, and note when it began. Does he hear ringing, buzzing, hissing, or other noises in one or both ears? If so, are the noises constant or intermittent? Does he experience dizziness? If so, when did he first notice it?
Begin the physical examination by inspecting the external ear for inflammation, boils, foreign bodies, and discharge. Then apply pressure to the tragus and mastoid to elicit tenderness. If you detect tenderness or external ear abnormalities, notify the physician to discuss whether an otoscopic examination should be done. (See Using an otoscope correctly, page 237.) During the otoscopic examination, note color change, perforation, bulging, or retraction of the tympanic membrane, which normally looks like a shiny, pearl gray cone.
Next, evaluate the patient’s hearing acuity, using the ticking watch and whispered voice tests. Then perform Weber’s and the Rinne tests to obtain a preliminary evaluation of the type and degree of hearing loss. (See Differentiating conductive from sensorineural hearing loss, page 316.)
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Source: Handbook of Signs & Symptoms (Third Edition), 2006
Otorrhea:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Begin your evaluation by asking the patient when otorrhea began, noting how he recognized it. Did he clean the drainage from deep within the ear canal, or did he wipe it from the auricle? Have him describe the color, consistency, and odor of the drainage. Is it clear, purulent, or bloody? Does it occur in one or both ears? Is it continuous or intermittent? If the patient wears cotton in his ear to absorb the drainage, ask how often he changes it.
Then explore associated otologic symptoms, especially pain. Is there tenderness on movement of the pinna or tragus? Ask about vertigo, which is absent in disorders of the external ear canal. Also ask about tinnitus.
Next, check the patient’s medical history for recent upper respiratory infection or head trauma. Also, ask how he cleans his ears and if he’s an avid swimmer. Note a history of cancer, dermatitis, or immunosuppressant therapy.
Focus the physical examination on the patient’s external ear, middle ear, and tympanic membrane. (If his symptoms are unilateral, examine the uninvolved ear first as not to cross-contaminate.) Inspect the external ear, and apply pressure on the tragus and mastoid area to elicit tenderness. Then insert an otoscope, using the largest speculum that will comfortably fit into the ear canal. If necessary, clean cerumen, pus, or other debris from the canal. Observe for edema, erythema, crusts, or polyps. Inspect the tympanic membrane, which should look like a shiny, pearl-gray cone. Note color changes, perforation, absence of the normal light reflex (a cone of light appearing toward the bottom of the drum), or a bulging membrane.
Next, test hearing acuity. Have the patient occlude one ear while you whisper some common two-syllable words toward the unoccluded ear. Stand behind him so he doesn’t read your lips, and ask him to repeat what he heard. Perform the test on the other ear using different words. Then use a tuning fork to perform Weber’s and the Rinne tests. (See Differentiating conductive from sensorineural hearing loss, page 316.)
Complete your assessment by palpating the patient’s neck and his preauricular, parotid, and postauricular (mastoid) areas for lymphadenopathy. Also, test the function of cranial nerves VII, IX, X, and XI.
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Source: Handbook of Signs & Symptoms (Third Edition), 2006
Introduction: Ear, Nose, and Throat Disorders:
Assessment
(Professional Guide to Diseases (Eighth Edition))
After obtaining a thorough patient history of ear disease, inspect the auricle and surrounding tissue for deformities, lumps, and skin lesions. (See Structures of the external ear.) Ask the patient if he has ear pain. If you see inflammation, check for tenderness by moving the auricle and pressing on the tragus and the mastoid process. Check the ear canal for excessive cerumen, discharge, or foreign bodies.
Ask the patient if he has had episodes of vertigo or blurred vision. To test for vertigo, have the patient stand on one foot and close his eyes, or have him walk a straight line with his eyes closed. Ask him if he always falls to the same side and if the room seems to be spinning.
Audiometric testing
Audiometric testing evaluates hearing and determines the type and extent of hearing loss. The simplest but least reliable method for judging hearing acuity consists of covering one of the patient’s ears, standing 18" to 24" (46 to 61 cm) from the uncovered ear, and whispering a short phrase or series of numbers. (Block the patient’s vision to prevent lip reading.) Then ask the patient to repeat the phrase or series of numbers. To test hearing at both high and low frequencies, repeat the test in a normal speaking voice. (As an alternative, you can hold a ticking watch to the patient’s ear.)
If you identify a hearing loss, further testing is necessary to determine if the loss is conductive or sensorineural. A conductive loss can result from faulty bone conduction (inability of the eighth cranial nerve to respond to sound waves traveling through the skull) or faulty air conduction (impaired transmission of sound through ear structures to the auditory nerve and, ultimately, the temporal lobe of the brain).
Sensorineural hearing loss results from damage to the cochlear or vestibulocochlear nerve, which can result from aging and prolonged exposure to high-frequency or loud noises.
The following tests assess bone and air conduction:
❑ Impedance audiometry detects middle ear pathology, precisely determining the degree of tympanic membrane and middle ear mobility. One end of the impedance audiometer, a probe with three small tubes, is inserted into the external canal; the other end is attached to an oscillator. One tube delivers a low tone of variable intensity, the second contains a microphone, and the third, an air pump. A mobile tympanic membrane reflects minimal sound waves and produces a low-voltage curve on the graph. A tympanic membrane with decreased mobility reflects maximal sound waves and produces a high-voltage curve.
❑ Pure tone audiometry uses an audiometer to produce a series of pure tones of calibrated decibels (dB) of loudness at different frequencies (125 to 8,000 Hz). These test tones are conveyed to the patient’s ears through headphones or a bone conduction (sound) vibrator. Speech threshold represents the loudness at which a person with normal hearing can perceive the tone. Both air conduction and bone conduction are measured for each ear, and the results are plotted on a graph. If hearing is normal, the line is plotted at 0 dB. In adults, normal hearing may range from 0 to 25 dB.
❑ Rinne test: The base of a lightly vibrating tuning fork is placed on the mastoid process (bone conduction). Then the fork is moved to the front of the meatus, where the patient should continue to hear the vibrations (air conduction). The patient must determine which sounds are louder. In a positive Rinne test, air conduction is greater than bone conduction, which may suggest sensorineural hearing loss. In a negative Rinne test, bone conduction is greater than air conduction, which may suggest a conductive loss.
❑ Speech audiometry uses the same technique as pure tone audiometry, but with speech, instead of pure tones, transmitted through the headset. (A person with normal hearing can hear and repeat 88% to 100% of transmitted words.)
❑ Tympanometry, using the impedance audiometer, measures tympanic membrane compliance with air pressure variations in the external canal and determines the degree of negative pressure in the middle ear.
❑ Weber’s test (used for testing unilateral hearing loss): The handle of a lightly vibrating tuning fork is placed on the midline of the forehead. Normally, the patient should hear sounds equally in both ears. With conductive hearing loss, sound lateralizes (localizes) to the ear with the poorest hearing. With sensorineural loss, sound lateralizes to the better functioning ear.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Hearing loss:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient reports hearing loss, ask him to describe it fully. Is it unilateral or bilateral? Continuous or intermittent? Ask about a family history of hearing loss. Then obtain the patient’s medical history, noting chronic ear infections, ear surgery, and ear or head trauma. Has the patient recently had an upper respiratory tract infection? After taking a drug history, have the patient describe his occupation and work environment.
Next, explore associated signs and symptoms. Does the patient have ear pain? If so, is it unilateral or bilateral? Continuous or intermittent? Ask the patient if he has noticed discharge from one or both ears. If so, have him describe its color and consistency, and note when it began. Does he hear ringing, buzzing, hissing, or other noises in one or both ears? If so, are the noises constant or intermittent? Does he experience any dizziness? If so, when did he first notice it?
Begin the physical examination by inspecting the external ear for inflammation, boils, foreign bodies, and discharge. Then apply pressure to the tragus and mastoid to elicit tenderness. If you detect tenderness or external ear abnormalities, ask the physician whether an otoscopic examination should be done. (See Using an otoscope correctly, page 289.) During the otoscopic examination, note any color change, perforation, bulging, or retraction of the tympanic membrane, which normally looks like a shiny, pearl gray cone.
Next, evaluate the patient’s hearing acuity, using the ticking watch and whispered voice tests. Then perform the Weber and Rinne tests to obtain a preliminary evaluation of the type and degree of hearing loss. (See Differentiating conductive from sensorineural hearing loss.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Otorrhea:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin your evaluation by asking the patient when the otorrhea began, noting how he recognized it. Did he clean the drainage from deep within the ear canal, or did he wipe it from the auricle? Have him describe the color, consistency, and odor of the drainage. Is it clear, purulent, or bloody? Does it occur in one or both ears? Is it continuous or intermittent? If the patient wears cotton in his ear to absorb the drainage, ask how often he changes it.
Then explore associated otologic symptoms, especially pain. Is there tenderness on movement of the pinna or tragus? Ask about vertigo, which is absent in disorders of the external ear canal. Also ask about tinnitus.
Next, check the patient’s medical history for recent upper respiratory infection or head trauma. Also, ask how he cleans his ears and if he’s an avid swimmer. Note a history of cancer, dermatitis, or immunosuppressant therapy.
Focus the physical examination on the patient’s external ear, middle ear, and tympanic membrane. (If his symptoms are unilateral, examine the uninvolved ear first as not to cross-contaminate.) Inspect the external ear, and apply pressure on the tragus and mastoid area to elicit tenderness. Then insert an otoscope, using the largest speculum that will comfortably fit into the ear canal. If necessary, clean cerumen, pus, or other debris from the canal. Observe for edema, erythema, crusts, or polyps. Inspect the tympanic membrane, which should look like a shiny, pearl-gray cone. Note color changes, perforation, absence of the normal light reflex (a cone of light appearing toward the bottom of the drum), or a bulging membrane.
Next, test hearing acuity. Have the patient occlude one ear while you whisper some common two-syllable words toward the unoccluded ear. Stand behind him so he doesn’t read your lips, and ask him to repeat what he heard. Perform the test on the other ear using different words. Then use a tuning fork to perform the Weber and Rinne tests. (See Differentiating conductive from sensorineural hearing loss, page 397.)
Complete your assessment by palpating the patient’s neck and his preauricular, parotid, and postauricular (mastoid) areas for lymphadenopathy. Also, test the function of cranial nerves VII, IX, X, and XI.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Earache [Otalgia]:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Ask the patient to characterize his earache. How long has he had it? Is it intermittent or continuous? Is it painful or slightly annoying? Can he localize the site of the pain? Does he have pain in any other areas, such as the jaw?
Ask about recent ear injury or other trauma. Does swimming or showering trigger ear discomfort? Is discomfort associated with itching? If so, find out where the itching is most intense and when it began. Ask about ear drainage and, if present, have the patient characterize it. Does he hear ringing, “swishing,” or other noises in his ears? Ask about dizziness or vertigo. Does it worsen when the patient changes position? Does he have difficulty swallowing, hoarseness, neck pain, or pain when he opens his mouth?
Find out if the patient has recently had a head cold or problems with his eyes, mouth, teeth, jaws, sinuses, or throat. Disorders in these areas may refer pain to the ear along the cranial nerves.
Finally, find out if the patient has recently flown, been to a high-altitude location, or been scuba diving.
Begin your physical examination by inspecting the external ear for redness, drainage, swelling, or deformity. Then apply pressure to the mastoid process and tragus to elicit any tenderness. Using an otoscope, examine the external auditory canal for lesions, bleeding or discharge, impacted cerumen, foreign bodies, tenderness, or swelling. Examine the tympanic membrane: Is it intact? Is it pearly gray (normal)? Look for tympanic membrane landmarks: the cone of light, umbo, pars tensa, and the handle and short process of the malleus. (See Using an otoscope correctly.) Perform the watch tick, whispered voice, Rinne, and Weber’s tests to assess for hearing loss.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Hearing Loss:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
Gross tests of hearing are only helpful to confirm significant hearing asymmetry or to detect profound hearing loss. With one ear covered, the patient tries to hear soft sounds such as the tick of a watch, scratching of two fingers rubbed together, or a softly whispered voice.
A. Visual examination of ears. Inspect the canal and TM to rule out obvious causes of CHL. Cerumen impaction is a remarkably common and easily corrected cause of hearing loss. Pneumoscopy to check for normal movement of the TM helps rule out perforation, atelectasis, eustachian tube dysfunction, stiffened TM, ossicular disruption, and middle ear effusion.
B. Weber test. With a vibrating tuning fork placed on the top of the head, the patient is asked to describe the sound heard. The patient will perceive the sound to be louder in the affected ear in CHL, because the background noise will be absent on that side. The unaffected ear will be perceived as louder in SNHL.
C. Rinne test. With the vibrating tuning fork placed on the mastoid, the patient detects bone conduction (BC). The tuning fork is removed when the patient can no longer hear the sound. Then the tuning fork is held next to the ear to test for air conduction (AC). In an individual with normal hearing, AC is significantly better than BC. CHL will reduce AC, with little effect on BC.
Testing
A simple audiogram performed at several frequency responses may detect individuals at risk for hearing loss. Although the sensitivity is good (93% to 95%), the poor specificity (60% to 74%) can result in many false-positive findings (3).
A. Audiography. Two forms of testing provide reproducible information about the patient. Pure tone testing documents the exact number of decibels heard at a given frequency. Unfortunately, it describes nothing about the ability to discriminate language. On the other hand, speech detection better estimates impairment of actual language function, but requires a much more cooperative and attentive patient.
B. Auditory-evoked response. Able to detect the electroencephalographic stimulation caused by repetitive sounds, this examination is useful in the obtunded, uncooperative, or very young patient.
C. Computed tomography (CT). In the setting of traumatic loss of hearing, CT is fast, less expensive than magnetic resonance imaging (MRI), and able to detect abnormalities within the petrous ridge where fractures can affect hearing (4). Likewise, bleeding in the CNS is readily seen. CT is also useful to examine for causes of CHL such as tumors, middle ear anomalies, myringosclerosis, and cholesteatoma.
D. MRI. In patients with SNHL, MRI with gadolineum is superior to CT because certain CNS diseases (MS or vascular infarcts) are more easily identified. In addition, acoustic neuromas and labyrinth disorders, often too small to be seen with CT, may be visualized with MRI (4).
Diagnostic assessment
Separation into CHL and SNHL, and assessment of severity help determine the best diagnostic approach (2).
A. Conductive hearing loss. Although bothersome, these disorders are rarely severe or life threatening. Systematic history and physical examination normally will easily localize the site of hearing loss.
B. Sensorineural hearing loss. Acoustic neuroma (AN), one of the most feared causes of hearing loss, is actually a nerve sheath tumor accounting for 1% of SNHL; 95% of patients with AN present with gradual progression of unilateral hearing loss (4). Tinnitus and vestibular symptoms are less common. In contrast, Ménière’s disease causes a fluctuating but progressive loss of hearing associated with tinnitus and episodic vertigo. Other causes of SNHL can be severe, rapidly progressive, and associated with severe side effects or potential mortality. Rapid systematic evaluation, including MRI in patients aged less than 65 years, should be conducted. For patients over the age of 65 years, exclusion of presbycusis and otosclerosis should prompt the same thorough evaluation.
References
1. Maggi S, Minicuci N, Martini A, et al. Prevalence rates of hearing impairment and comorbid conditions in older people: the Veneto Study. J Am Geriatr Soc 1998;46:
1069–1074.
2. Weber P, Klein A. Hearing loss. Med Clin North Am 1999;83:125–137.
3. Weissman J. Hearing loss. Radiology 1996;199:593–611.
4. Moore A, Siu A. Screening for common problems in ambulatory elderly: clinical confirmation of a screening instrument. Am J Med 1996;100:438–443.
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Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Hearing Loss:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Conductive hearing loss presents with loss of low tones and vowels. Sensorineural hearing loss produces impaired high tone perception, with diminished speech discrimination—especially for female voices—and hearing ringing sounds (tinnitus). Hyperacusis (the sensation that sounds are overly loud to the point of discomfort) is associated with sensorineural cochlear hearing loss. Paracusis (words perceived more clearly in a noisy environment) is associated with conductive middle ear hearing loss.
A reliable qualitative screen for high frequency hearing loss is the ability to hear whispered speech. Stand behind the patient at arm’s length and test one ear at a time. Whisper a combination of 3 letters and numbers (e.g., 4-K-2), and ask the patient to repeat it. The screen is passed when 3/6 are correctly identified. The 256 Hz tuning fork tests 10 to 15 dB, and the 512 Hz 20 to 30 dB. The Rinne test (bone conduction . air conduction) is sensitive to a 20 dB hearing loss. The Weber test is sensitive to 5 dB of hearing loss. A tuning fork is placed in the midline. With conductive loss, it lateralizes to the affected ear, and with sensorineural loss, to the unaffected ear.
Pneumoscopy is performed by first insufflating the ear then releasing. A nonmobile TM may be due to fluid or a mass in the middle ear cavity, or a stiff or sclerotic TM. A hypermobile TM may indicate ossicular chain disruption. A TM that moves only with negative pressure can be due to a retracted TM or a middle ear with a blocked eustacian tube, with resulting negative ear pressure.
Acute hearing loss occurs with infection, traumatic tympanic membrane rupture, or acute vascular event. Unilateral sensorineural loss suggests an inner ear disorder such as Meniere disease or an acoustic neuroma.
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Source: Field Guide to Bedside Diagnosis, 2007
Ear Pain/Discharge:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
If ear pain is present without ear findings, consider referred pain from the tonsils, teeth, trachea, or temporomandibular joint. Ear pain may be an early sign of nasopharyngeal carcinoma. Lesions of the anterior portion of the tongue refer pain in front of the ear whereas the posterior one-third of the tongue refers pain to within the ear.
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Source: Field Guide to Bedside Diagnosis, 2007
Earache:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Begin your physical examination by inspecting the external ear for redness, drainage, swelling, or deformity. Then apply pressure to the mastoid process and tragus to elicit tenderness. Using an otoscope, examine the external auditory canal for lesions, bleeding or other discharge, impacted cerumen, foreign bodies, tenderness, or swelling. Examine the tympanic membrane. Is it intact? Look for tympanic membrane landmarks: the cone of light, umbo, pars tensa, and the handle and short process of the malleus. (See Using an otoscope correctly.) Perform watch tick, whispered voice, Rinne, and Weber’s tests to assess for hearing loss.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Hearing loss:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Begin the physical examination by inspecting the external ear for inflammation, boils, foreign bodies, and discharge. Then apply pressure to the tragus and mastoid to elicit tenderness. If you detect tenderness or external ear abnormalities, notify the physician to discuss whether an otoscopic examination should be done. During the otoscopic examination, note any color change, perforation, bulging, or retraction of the tympanic membrane, which normally looks like a shiny, pearl gray cone.
Next, evaluate the patient’s hearing acuity, using the ticking watch and whispered voice tests. Then perform the Weber’s and Rinne tests to obtain a preliminary evaluation of the type and degree of hearing loss. (See Differentiating conductive from sensorineural hearing loss, page 330.)
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Otorrhea:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Focus the physical assessment on the patient’s external ear, middle ear, and tympanic membrane. (If his symptoms are unilateral, examine the uninvolved ear first to avoid cross-contamination.) Inspect the external ear, and apply pressure on the tragus and mastoid area to elicit tenderness. Then insert an otoscope, using the largest speculum that will comfortably fit into the ear canal. If necessary, clean cerumen, pus, or other debris from the canal. Observe for edema, erythema, crusts, or polyps. Inspect the tympanic membrane, which should look like a shiny, pearl gray cone. Note color changes, perforation, absence of the normal light reflex (a cone of light appearing toward the bottom of the drum), or a bulging membrane.
Next, test hearing acuity. Have the patient occlude one ear while you whisper some common two-syllable words toward the unoccluded ear. Stand behind him so he doesn’t read your lips, and ask him to repeat what he heard. Perform the test on the other ear using different words. Then use a tuning fork to perform Weber’s and Rinne tests.
Complete your assessment by palpating the patient’s neck and his preauricular, parotid, and postauricular (mastoid) areas for lymphadenopathy. Also, test the function of cranial nerves VII, IX, X, and XI.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Earache:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Most commoncauses of ear pain are acute and chronic otitis media, otitis externa, cerumenimpaction, foreign body, and trauma.History and careful exam of externalear, external auditory canal, and middle ear are diagnostic. Ifexam of these structures is normal, possibility of referred earpain must be considered. Head, face, nose, mouth, pharynx, and neckshould be carefully examined.Radiographs of temporal bone and mastoidregion, CT, and MRI are helpful in diagnosis of suspected neoplasmof external auditory canal, middle ear, mastoid, or temporal bone.
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Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Hearing Loss and Deafness:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Auditoryand language findings listed in Table26.1 are indications for possible hearing loss or deafness.Suspected hearing loss should be investigatedto determine the type, severity, and cause.Any child with suspected hearing lossshould be referred for audiologic evaluation. Speech and languageassessment is often necessary. Neurologic and otolaryngologic consultationmay be required, depending on suspected problem.
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Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Hearing loss:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient reports hearing loss, ask him to describe it. Is it unilateral or bilateral? Continuous or intermittent? Ask about a family history of hearing loss. Then obtain the patient's medical history, noting chronic ear infections, ear surgery, and ear or head trauma. Has the patient recently had an upper respiratory tract infection? After taking a drug history, have the patient describe his occupation and work environment.
Next, explore associated signs and symptoms. Does the patient have ear pain? If so, is it unilateral or bilateral, or continuous or intermittent? Ask the patient if he has noticed discharge from one or both ears. If so, have him describe its color and consistency, and note when it began. Does he hear ringing, buzzing, hissing, or other noises in one or both ears? If so, are the noises constant or intermittent? Does he experience dizziness? If so, when did he first notice it?
Begin the physical examination by inspecting the external ear for inflammation, boils, foreign bodies, and discharge. Then apply pressure to the tragus and mastoid to elicit tenderness. If you detect tenderness or external ear abnormalities, notify the physician to discuss whether an otoscopic examination should be done. (See Using an otoscope correctly, page 223.) During the otoscopic examination, note color change, perforation, bulging, or retraction of the tympanic membrane, which normally looks like a shiny, pearl gray cone.
Next, evaluate the patient's hearing acuity, using the ticking watch and whispered voice tests. Then perform Weber's and the Rinne tests to obtain a preliminary evaluation of the type and degree of hearing loss. (See Differentiating conductive from sensorineural hearing loss, page 304.)
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Otorrhea:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin your evaluation by asking the patient when otorrhea began, noting how he recognized it. Did he clean the drainage from deep within the ear canal, or did he wipe it from the auricle? Have him describe the color, consistency, and odor of the drainage. Is it clear, purulent, or bloody? Does it occur in one or both ears? Is it continuous or intermittent? If the patient wears cotton in his ear to absorb the drainage, ask how often he changes it.
Then explore associated otologic symptoms, especially pain. Is there tenderness on movement of the pinna or tragus? Ask about vertigo, which is absent in disorders of the external ear canal. Also ask about tinnitus.
Next, check the patient's medical history for recent upper respiratory infection or head trauma. Also, ask how he cleans his ears and if he's an avid swimmer. Note a history of cancer, dermatitis, or immunosuppressant therapy.
Focus the physical examination on the patient's external ear, middle ear, and tympanic membrane. (If his symptoms are unilateral, examine the uninvolved ear first to avoid cross-contamination.) Inspect the external ear, and apply pressure on the tragus and mastoid area to elicit tenderness. Then insert an otoscope, using the largest speculum that will comfortably fit into the ear canal. If necessary, clean cerumen, pus, or other debris from the canal. Observe for edema, erythema, crusts, or polyps. Inspect the tympanic membrane, which should look like a shiny, pearl-gray cone. Note color changes, perforation, absence of the normal light reflex (a cone of light appearing toward the bottom of the drum), or a bulging membrane.
Next, test hearing acuity. Have the patient occlude one ear while you whisper some common two-syllable words toward the unoccluded ear. Stand behind him so he doesn't read your lips, and ask him to repeat what he heard. Perform the test on the other ear using different words. Then use a tuning fork to perform Weber's and the Rinne tests. (See Differentiating conductive from sensorineural hearing loss, page 304.)
Complete your assessment by palpating the patient's neck and his preauricular, parotid, and postauricular (mastoid) areas for lymphadenopathy. Also, test the function of cranial nerves VII, IX, X, and XI.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Earache [Otalgia]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Ask the patient to characterize his earache. How long has he had it? Is it intermittent or continuous? Is it painful or slightly annoying? Can he localize the site of ear pain? Does he have pain in other areas such as the jaw? Does he experience any associated hearing loss?
Ask about recent ear injury or other trauma. Does swimming or showering trigger ear discomfort? Is discomfort associated with itching? If so, find out where the itching is most intense and when it began. Ask about ear drainage and, if present, have the patient characterize it. Does he hear ringing, “swishing,” or other noise in his ears? Ask about dizziness or vertigo. Does it worsen when the patient changes position? Does he have difficulty swallowing, hoarseness, neck pain, or pain when he opens his mouth?
Find out if the patient has recently had a head cold or problems with his eyes, mouth, teeth, jaws, sinuses, or throat. Disorders in these areas may refer pain to the ear along the cranial nerves.
Find out if the patient has flown, been to a high-altitude location, or been scuba diving.
Begin your physical examination by inspecting the external ear for redness, drainage, swelling, or deformity. Then apply pressure to the mastoid process and tragus to elicit tenderness. Using an otoscope, examine the external auditory canal for lesions, bleeding or discharge, impacted cerumen, foreign bodies, tenderness, or swelling. Examine the tympanic membrane: Is it intact? Is it pearly gray (normal)? Look for tympanic membrane landmarks: the cone of light, umbo, pars tensa, and the handle and short process of the malleus. (See Using an otoscope correctly.) Perform the watch tick, whispered voice, Rinne, and Weber's tests to assess for hearing loss.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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