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Examination Of The Ear

HISTORY TAKING:
Ear discharge:
Left/Right/Both
Intermittent/Continuous
Profuse/Scanty
Mucoid/Mucopurulent/Blood tinged
Foul smelling/Non foul smelling
Associated with URTI
Duration:
Hearing loss: Left/Right/Both
Onset – Sudden/Insidious
Progressive/Nonprogressive
Degree of deafness
Relation to noisy surroundings
Duration:
Earache: Left/Right/Both
Radiation/Nonradiation
Aggravated on chewing
Duration:
Tinnitus: Left/Right/Both
Type – Pulsatile/Hissing/
High pitched/Low pitched
Associated with deafness
Duration:
Dizziness: Duration of attack
Onset – Sudden/insidious/Episodic
Associated with nausea or vomiting
Aggravated by change of posture/ Turning to side- Left/Right,/Bending head
Associated with hearing loss/tinnitus/ear discharge
Facial weakness: Left/Right/Both
Onset – Sudden/Insidious
Associated drooling saliva/ inability to close the eye/accumulation of food in one side of the cheek
Duration:
Other symptoms: Itching
Aural fullness
Headache
Swelling of the ear
Swelling/discharge in front or behind the ear
Trauma to the ear/Bleeding from the ear
History suggestive of complication: Fever
Headache
Nausea, Vomiting
Diplopia, Blurring of vision
Facial weakness
PAST HISTORY: Ear disease
Otological surgeries
Diabetes mellitus
Exanthematous fever
Tuberculosis
Ototoxic drugs
Noise exposure
Trauma to head or ear
FAMILY HISTORY: Deafness
Tuberculosis
PERSONAL HISTORY: Dip bath
Swimming in the pool
Ear manipulation
Smoking
Allergies
External appearance: RIGHT LEFT
Preauricular area- Skin tags
Swelling
Sinuses
Discharge
Tragal tenderness
Temporomandibular joint
– Tenderness present/absent
Pinna- Skin over the pinna (signs of inflammation)
Swelling
Tenderness
Trauma
Post-auricular area- Scar
Fullness of post-aural sulcus
Swelling
Discharge
Sinuses
Mastoid tenderness
Odema over mastoid (Battle's sign)
External auditory canal- Wax/Keratosis
Foreign body
Skin excoriation
Fungal debris
Discharge- scanty/profuse
Mucoid/Mucopurulent
Blood stained
Foul smelling
Granulations
Swelling
Tympanic membrane - Colour
Cone of light
Mobility (Sieglisation/Valsalva's manoeuvre)
Eustachian tube patency-
Valsalva's/Toynbee's/Frenzel
Tympanosclerotic patches
Bulging of the tympanic membrane- Pars tensa/Pars flacida
Retraction (Grade I – IV)
Cholesteatoma
Perforation-Pars tensa/Pars flacida/Attic
Size
Shape
Middle ear structures visible thr' perforation –
Foreshortening of handle of Malleus
Incudostapedial joint
Status of middle ear mucosa-
Edematous/Normal
Visible round window niche
Oval window
Eustachian tube opening
Tunning fork tests: RIGHT LEFT
Rinne's (256 Hz)
(512 Hz)
(1024 Hz)
Weber's
ABC
Gelle's test
Facial Nerve
Fistula sign
ASSESMENT OF VESTIBULAR FUNCTIONS
Static testing:
Romberg test
Tandem walking
Unterberger's test
Nystagmus:
Spontaneous nystagmus- I/II/III degree
Induced nystagmus-
Dix Hallpike's Manoeuvre
Fistula test
Caloric test- Fitzgerald Hallpike's
Modified Kobrak's test
Tullio's phenomenon
Pendulum tracking
Optokinetic drum
Barany's rotation test
Cerebellar function tests:
Dysmetria and past pointing
Asynergia
Dysdiadochokinesis
Rebound
Romberg's test
Tandem walking
Finger nose test
Finger-finger test
Examination of eyes:
Pupil reaction
Ocular movements
Corneal reflex
Fundal examination
Examination of cranial nerves:
IX-X Nerve – PMovements of the soft palate
Gag reflex
XI Nerve- Shrugging of shoulders
Tension in the contra lateral SCM
XII Nerve- Tongue movements/Fasciculation's/Fibrillations
Wasting
Taste sensations
CLINICAL IMPRESSION:
INVESTIGATIONS
Puretone Audiogram:
Impedence measurements: Tympanometry
Stapedius reflex
Speech Audiometry:
Tests of recruitment: Fowler's test: Alternate Binaural loudness balance test
Loudness discomfort level
Tone decay test:
Auditory evoked potential: BERA
EEG
Electrocochleography
Otoacoustic emissions
Radiological evaluation

X Ray Perorbital view:

CT Scan:

MRI:

Routine blood investigations:

Histopathological examination:

Other investigations:

SURGERY PLANNED:

SURGERY EXECUTED:

INTRA OPERATIVE FINDINGS:

POST OPERATIVE PERIOD/COMPLICATIONS:

COURSE OF STAY IN THE HOSPITAL:

ADVICE:

FOLLOW UP:

POST OPERATIVE AUDIOLOGICAL EVALUATION:

At 3 Weeks:
At 3 Months:
At 6 Months:
 
 
Otology Master Class
From the Organizing desk

Dear friends,

MESIARC CME is here again. We have always strived to bring you the best in Otology, over the past 10 years, Our live surgery workshops, have focused on cutting edge surgery, detailed teaching, scientific deliberations of the highest order and top class video coverage from one of the most advanced otological theatre suites in the world this time, we are focusing on the enigma of budding otologists - cholesteatoma and Otosclerosis. Two very diverse conditions, but requiring surgical expertise of the highest order to deliver good results. The two-day surgical workshops will feature both myself and a luminary in Otology, Dr. Ashesh Bhumker from Thane, Mumbai and we would be demonstrating in detail the finer aspects of surgical techniques that can be adapted by a keen otologist to sustain good results over time.

We have lined up an array of diverse cases- and the techniques that we intend to demonstrate include minimal access stapedotomy, Laser stapes surgery, stapes surgery with stapes head amputation for tendon preservation, bone obliteration technique for cholesteatoma, a variety of grafting techniques, intact canal wall tympanoplasty for limited cholesteatoma and a series of revision surgeries.

Do send in your registrations early as we have to limit attendance to 70 seats. A smaller crowd is ideal for active discussions which is something so characteristic of MESIARC CME programs and we do not want to deviate from that agenda.


Yours truly,

Manoj MP  
Organizing chairman

Otology in Perspective Live Surgery 2015
From the Organizing desk

Mesiarc brings you a unique live surgical workshop- a demonstration of both endoscopic and microscopic otologic skills.

Otologic surgery is special for its intricate anatomy, extreme precision and attention to detail. Traditionally done with the operating microscope, and now in some centers across the world with the endoscope, the repetoire of the art is widening.

Confusion persists. Advocates of endoscopic work claim that the microscope is passe, and traditional surgeons laugh off the ability of the one handed

The truth lies somewhere in between; there are specific conditions that require either of both of the techniques. Dogmatism, they say, is the end of science.

Mesiarc brings you a unique live surgical workshop- a demonstration of both endoscopic and microscopic otologic skills.

MESIARC has always stood for dissipation of knowledge and the live surgical workshops are not pubilicity events, nor are they grandiose. We have just one agenda- to educate.

This workshop with a difference aims to demonstrate both endoscopic and microsopic skills in otologic surgery, while attempting to define which is more suitable for what. Do come and enjoy!


Yours truly,

Manoj MP  
Organizing chairman

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