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:
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)
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 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:

Welcome to my ENT department which offers comprehensive medical and surgical services at affordable cost to the patients in Kerala and beyond. The prime object behind this movement is to provide all sorts of advanced treatment in ENT,

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