PCM: Ear Exam

=Ear Exam Objectives=

Describe normal landmarks for the auricle, external canal, and tympanic membrane



 * Use multiple landmarks to distinguish between right and left ears based on an image of the tympanic membrane. 

Demonstrate techniques to maximize visibility and patient comfort on exam.

 * Pull scapha of ear posterior-superiorly in order to open up auditory canal. Firm but gentle grasp.
 * Rest ulnar side of hand gently against patient's face. This gives you a cushion if the patient jerks.
 * Insert speculum of otoscope gradually.
 * Avoid touching speculum to inner 2/3 of auditory canal (bony). --> pain.

Demonstrate ability to check membrane motility with insufflation and describe how to interpret it

 * Avoid the hassle: ask patient to plug nose and clear ears by gently blowing while examining the tympanic membrane for movement.
 * More involved:
 * Speculum and ear need to form a tight seal. Use a larger speculum or a rubber ring around speculum.
 * Attach inflation ball to otoscope.
 * Inflate and deflate. Watch tympanic membrane.

Demonstrate Weber and Rinne test and interpret results

 * 1) Weber: Test lateralization of conductive or sensorineural hearing loss
 * 2) 512 Hz tuning fork. Place on midline vertex.
 * 3) Ask patient to describe sound localization. Avoid leading questions.
 * 4) If necessary, retest with patient occluding 1 ear. Sounds is strongest in occluded ear. (Conductive hearing loss)
 * 5) Rinne: Test bone conduction
 * 6) 512 Hz tuning fork. Mastoid process.
 * 7) Time until patient cannot hear
 * 8) Quickly move in front of ear. Time until patient cannot hear.
 * 9) Air-to-bone conductance should be 2:1.


 * If air conduction is heard longer than bone conduction the test is positive (positive Rinne), the Rinne Test Wikipedia

Perform Ear Exam

 * 1) Inspect external ear
 * 2) Examine ears bilaterally
 * 3) Test auditory acuity by whisper, rubbing fingers
 * 4) Weber test (512 Hz, top of head)
 * 5) Rinne test (512 Hz, mastoid process)