When screening for hearing loss, examine each ear individually in a quiet room. Audiogram, speech audiometry, impedance audiometry.Gelle negative: Despite positive pressure, there is no change in hearing in the patient.
→ Hearing is normal in the middle ear or there might be a problem in the middle ear that restricts the mobility of the ossicles. The sound of the tuning fork is perceived by the patient to be considerably weaker with the pneumatic speculum applied than without the pneumatic speculum. Gelle positive: Positive pressure disturbs both bone and air conduction.Procedure: The vibrating tuning fork is placed against the forehead and the auditory canal is sealed using a pneumatic speculum, which creates positive pressure in the external auditory canal.Description: to evaluate the mobility of the ossicles, e.g., in the diagnosis of otosclerosis.Sensorineural hearing loss in the left earīilateral, symmetrical conductive hearing loss Sensorineural hearing loss in the right ear Normal hearing or bilateral sensorineural hearing loss Still able to hear tuning fork over the outer ear → there is no conductive hearing loss ( Rinne test is positive) possible sensorineural hearing loss (air conduction > bone conduction) if there is diminished hearing in the examined ear.Unable to hear the tuning fork → there is conductive hearing loss (bone conduction > air conduction) in the examined ear ( Rinne test is negative).Air conduction is normally greater than bone conduction, so the patient should still be able to hear the tuning fork next to the outer ear after they can no longer hear it when placed on the mastoid process.Once the patient no longer hears a tone, immediately hold the “U” part of the fork over the outer ear and ask the patient if they can still hear it. Place the base of a vibrating tuning fork on the mastoid process of the ear.Rinne test: tests for air conduction vs bone conduction in the examined ear.No lateralization → normal hearing or bilateral hearing loss.Lateralization → asymmetric hearing loss.The sound is normally heard equally in both ears.Place the base of a vibrating tuning fork on the middle of the forehead and ask the patient from which ear the sound is louder.Weber test: tests for lateralization (sound is heard louder in one ear than the other).Performed in order to distinguish between conductive hearing loss and sensorineural hearing loss.Interpretation : : If any asymmetry is detected, or the patient complains of impaired hearing, further evaluation is indicated → See hearing loss.Finger rub test: Place your fingers several centimeters from either ear → Rub your fingertips together and ask the patient if they heard it.Whispered voice test: While standing behind the patient, whisper a phrase or numbers in each ear → Ask the patient to repeat what you whispered.It is usually only performed in adults if they have mentioned ear discomfort.
Otoscopy is an integral part of all pediatric examinations.
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With your free hand, pull the ear up and in a posterior direction to straighten the canal as you insert the otoscope at a slightly downward angle.Stabilize your otoscope hand by placing the fourth and fifth digits on the patient's head.Angle the otoscope handle either directly downward or towards the patient's forehead.Place the largest speculum that comfortably fits in the patient's ear on the head of the otoscope and turn on the light source.For patients complaining of ear pain or discharge, gently move the auricle up and down, and apply pressure to the tragus and the mastoid process.
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