ABSTRACT
Establishes onset and duration of hearing loss Establishes whether patient has had previous ENT surgery Establishes whether one or both ears are affected Establishes whether hearing loss is to high-pitched or low-pitched sounds Establishes severity of hearing loss and impact on patient’s life Enquires about associated symptoms – vertigo and tinnitus, discharge, loss of balance, pain Enquires about possible causal factors – noise exposure, treatment with ototoxic drugs, family history Asks if patient is currently in any pain
Examination
Tests hearing in each ear using speech Performs the Rinne test using a 512 Hz tuning fork Performs the Weber test using a 512 Hz tuning fork Inspects outer ears and behind the ears for any abnormalities and surgical scars Holds otoscope and patient’s ear correctly Inspects ear canals (otitis externa, wax) Inspects tympanic membranes and identifies normal anatomy
Cleans hands by washing or using alcohol gel
Fluency of examination Competence in presenting findings, summarizing and forming differential diagnoses
KEY If a history is required, you should enquire about common causal factors of hearing loss, namely noise exposure and treatment with ototoxic drugs (ask if they have ever had a serious infection requiring intravenous antibiotics); and ask about any family history of hearing loss – a positive history might be suggestive of Meniére’s disease.
