👂 Finals: Examination of Ear
Introduction
The examination of the ear is a crucial component of an ENT exam. Final year medical students should be prepared to perform this skill with precision and fluency. Practicing on both normal and pathological ears will help in identifying abnormalities with greater ease. During exams, actors may simulate hearing loss, so the correct use of hearing tests is essential.
It is likely you will be picking up the external clues of ear related pathology, so keep this in mind when examining the ear!
Preparation and Introduction
- Infection control: Clean your hands using alcohol gel, and mention the importance of infection control.
- Introduce yourself to the patient: "Hello, I am [Your Name] a final year medical student. I understand you’ve had some trouble with your ears."
- Confirm the name and DOB of the patient
- Consent and Explanation: "May I examine your ears and hearing - this will involve me having a look on the outside and inside of your ears, and performing some hearing tests. Is that okay?"
- Inform the patient you’ll explain each step of the process and encourage them to ask any questions.
- Exposure: expose the ear, mastoid and neck - to expose any scars / hearing devices.
Inspection of the External Ear
- Ask about pain: Always ask if the patient is currently in pain. If so, handle the painful ear gently.
- Environment:
- Check for any objects / equipment that will give you clues.
- Hearing aids / mobility aids (giving an idea of balance)
- Ask which is the better ear?
- Then start with the better ear.
Key Areas to Inspect:
- Pinna: Look for erythema, scars (previous surgery), lesions, deformity (cauliflower ear, microtia), cartilage quality, and infections. Compare symmetry between ears.
- Mastoid: Move the pinna forward and check for pain.
- Pre-auricular area: Look for pits, sinuses, or fistulae.
- Conchal bowl: Examine for any abnormalities.