Ear Examination - Indications, Contraindications, and Procedure

Introduction:

Ear examination is an essential skill for all medical professionals. When they examine, findings may be simple to life-threatening conditions. An instrument called an otoscope is used to perform the examination procedure. An ear examination is done to know if one has an ear infection, hearing loss, or other symptoms and to check whether the treatment given is working or not.

What Is an Ear Examination?

Ear problems are common findings that medical professionals come across in everyday practice. These can be identified using an otoscope and a tuning fork. These are used to know whether the ear and parts of the ear are in good status or not. The ear consists of the external, middle, and inner ear.

• External Ear: It consists of the auricle (pinna), external auditory meatus and canal, and the external (lateral) layer of the tympanic membrane. The external ear can be examined directly by looking at it.

• Middle Ear: It is an air-filled cavity. It consists of three ossicles, an internal layer of the tympanic membrane, and a eustachian tube orifice. Tympanometry or pneumatic otoscopy can be used to examine the middle ear.

• Inner Ear: It consists of the vestibular system and cochlea. Both consist of bony and membranous portions. These parts cannot be visualized directly, but signs of the inner ear, and hearing loss, can be elicited.

What Are the Indications of Ear Examination?

A healthcare provider performs an examination if one has

• Ear pain.

• Infection in the ear.

• Loss of hearing.

• Ringing sounds in the ear.

• Dizziness.

• Fever.

• Discharge in the ear or bleeding.

• Other symptoms of the ear like vertigo, otalgia, otorrhea, vertigo, tinnitus, aural fullness, hearing loss, and facial weakness.

• One must differentiate between true vertigo and faint sensations (simple), lightheadedness, and disequilibrium due to cerebellar or gait disturbances.

• Nasopharyngeal carcinoma, a postnasal space disease to exclude occluded eustachian tube orifice.

What Are the Contraindications for Ear Examination?

When there is no willingness from an individual to participate in the ear examination, it is contraindicated.

What Are the Types of Equipment Required for Ear Examination?

The following types of equipment are required for ear examination.

• Otoscope: It enables one to see the pinna, external auditory canal, and tympanic membrane.

• Pneumatic Otoscope: It is used to assess the mobility of the tympanic membrane.

• Tuning Fork: It is used to differentiate between conductive and sensorineural hearing loss.

How Is the Ear Examination Conducted?

To conduct an ear examination, an examiner and an individual are required for effective procedures. In the case of children, parents with an experienced nurse or play specialist may be needed.

1. Preparation: An individual is made to sit on a chair so that operator may stand behind the individual. Before the examination is done, an individual should be asked if any pain is present in the ear. Then better ear must be examined first.

2. Technique:

General Examination: A general examination is performed first. This is followed by

• Free-field Hearing Test: This test is done to know about hearing loss and the degree of hearing impairment.

• Fistula Test: This test helps identify the perilymphatic fistula, which is an abnormal connection between the inner and middle ear.

• Tuning Fork Test: This test helps in differentiating conductive hearing loss and sensorineural hearing loss.

• Facial Nerve Functioning Test: Facial nerve passes through the middle ear. Hence in case of ear problems, it gets affected.

Depending on the clinical signs and symptoms, examinations of other cranial nerves, vestibular system, nose, throat, neck, or cerebellar systems are performed.

3. Inspection And Palpation:

• The ears should be visualized by the examiner for any asymmetry present.

• Inspection of preauricular and postauricular areas to be done.

• The mastoid and tragus should be palpated for any tenderness present, and pre or post-auricular lymphadenopathy should be checked.

Otoscopy:

• The pinna should be pulled posteriorly and upwardly to straighten the auditory canal and other parts.

• An otoscope should be inserted into the canal. Then the tympanic membrane should be assessed.

• A pneumatic otoscopy is done to assess the mobility of the tympanic membrane.

What Are the Normal Results of Ear Examination?

The normal results include the following.

• Ear canal size and shape color differ from person to person.

• The canal is skin-colored and has small hairs normally.

• Ear wax may be present.

• The eardrum is sightly gray colored and shiny pearl white.

• The light should reflect from the eardrum surface.

What Are the Risks Involved in Ear Examination?

• Very few risks are involved with ear examination.

• Chance of spreading of infection from one ear to another if the tip is not changed or cleaned before using it to another ear.

What Are the Clinical Significances of Ear Examination?

Many pathologies can be identified which are related to the ear.

• Foreign bodies that are present in the external auditory canal can be removed in the clinic.

• For otitis externa, topical antibiotics and steroids can be given. Oral antibiotics can be given in case of otitis media.

• Further investigations like computed tomography (CT) and MRI (magnetic resonance imaging) are used to identify problems.

• Further hearing tests like pure-tone audiometry and tympanometry are used to identify the problems.

Who Are the Healthcare Professionals Involved in Treating Ear Diseases?

A team of interprofessional is needed in the treatment plan for ear diseases.

• This team includes otolaryngologists, audiologists, neurologists, neurosurgeons, radiologists, pediatricians, and infectious disease specialists.

• In some countries, ENT (ear, nose, throat) nurses are involved in taking care of ear problems.

• The audiological department plays an important role in assessing hearing loss before and after surgery and in providing hearing aid devices.

Conclusion:

The ear is an important organ of the body. One can hear and respond to sounds if the ear works properly. Ear examination is an important procedure in many diseases related to the ear. Some congenital malformations also occur at birth, causing hearing impairment. If these problems are not treated at the right time, one has to compromise for good quality of life. Hence knowing in detail about ear function, tests, and symptoms of ear diseases, help one to seek advice from the healthcare provider at the earliest. Early diagnosis leads to effective treatment. This, in turn, helps in achieving a good quality of life.