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: |
| Ear ache: | 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 | Duration: |
| 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 | Duration: |
| History suggestive of complication: | Fever Headache Nausea, Vomiting Diplopia, Blurring of vision Facial weakness | Duration: |
| PAST HISTORY: | Ear disease Otological surgeries Diabetes mellitus Exanthematous fever Tuberculosis Ototoxic drugs Noise exposure Trauma to head or ear | Duration: |
| FAMILY HISTORY: | Deafness Tuberculosis | Duration: |
| PERSONAL HISTORY: | Dip bath Swimming in the pool Ear manipulation Smoking Allergies | Duration: |
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) |
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| Weber's ABC Gelle's test |
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| 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 Carnival Nerves: | IX-X Nerve – | PMovements of the soft palate Gag reflex |
| X1 Nerve – | Shrugging of shoulders Tension in the contra lateral SCM | |
| X11 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: