Talk:PCM: Ear Exam

Hi:

One of our objectives is to distinguish between conductive and neurosensory hearing loss; this is the purpose of the Rinne and Weber tests.

I reviewed the ear exam this evening and I think we need to make a correction to our protocol to fulfill the objectives. While this is not reflected in the U. Chicago film, it's our 5th objectives for the ear exam, in the Mosby reading, and in the Mosby film.

In order for the Rinne exam (mastoid, bone, then air conductance) to be a useful diagnostic, it needs to be timed and paired with a Weber. Recall that unilateral conductive loss will result in an increased auditory acuity in the effected ear with the Weber.

Take an example....Assume the right ear hears a sound louder than the left ear with a Weber test (fork on top of head). Then, there are two options: 1) increased acuity in an occluded ear (eg, the right) in the case of conductive hearing loss or 2) decreased acuity in the left ear due to neurosensory loss. The Weber alone cannot distinguish.

A negative Rinne would point to neurosensory loss in the left; a positive Rinee would point to conductive hearing loss. Failure to assess the relative hearing levels by timing the exam may not allow us to distinguish between these two options--which is the purpose of the exam. A qualitative check like U. Chicago follows can only identify complete hearing loss. A clinically meaningful result need not be a complete loss, but rather a relative in the bone-to-air conductance ratios between the sides. Put another way, even a subtle finding with the Rinne is clinically meaningful in interpreting the Weber.

I don't think this is beyond the scope of the course. Maybe this will be useful in our exam or GOSKE.