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Symptomatolorgy of ear diseases

Deafness'

a) On set

b)Duration

C) Nature of deafness

d) History of drug intake

e) Occupation

f) Family history

Hyperacusis

Hard of hearing

Tinnitus

Vertigo

Otorrhoea

Head ache

Otalgia :Pain may occur due to lesions in the ear itself.

Referred Otalgia :due to the conditions in the

surrounding areas.

Itching

Tullio Phenomenon : when the subject gets attacks ofdizziness or vertigo by loud sounds.

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Examination of the ear

Inspection The shape,size, colour ofthe skin,

swelling, ulceror scar.

Otoscopy :

E.A.C.

Tympanicmembrane :Gra ish white ,

Importantlandmark.

Short processof the M.

The anterior &posteriormalleolarfolds.

Handle of theMalleus

Umbo

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Investigation

Eustachian tubal patency

Valsalva Manoeuvre: toblow out forcibly whileclosing his nostril &and mouth. Thenasopharyngeal

pressure is increased Toynbees M. : to

swallow while closinghis nose and mouth vepressure is created in

nasopharynx Politzers method : The

nozzle of a Politzer bagis introduced into onenostril & both nostrils

are compressed withfin ers . Patient is

Hearing tests1. Voice Tests: There arevariation in intensity &clarity of the voice.

2. Rinne test(1855) : A512Hz tuning fork firmly

held with its steam .

Rinne +ve : NormallyAC Better than BC(AC>BC ) .

Rinne -ve : Conductivedeafness BC better thanAC ( BC>AC) .

Reduced Rinne +ve :SNHL. The intensities of

AC & BC are decreased .

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False negative Rinne: In unilateral severe deafness ,patient cannot hear by AC. The sound is transmitted tothe opposite ear and it is heard.

Rinne equal : Some times both AC&BC In equalintensities.

3. Weber test:

. Normal persons : Sound is heard in both ears equally or

in the center of the head.. Conductive deafness : The sound is lateralized to the

affected ear, or the worse ear if both ears are involved.

. SNHL : The sound is lateralized to normal ear or betterif both are involved.

4. ABC test:

ABC is reduced in SNHL

5. Routine blood

6. Swab of ear discharge

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ELECTRIC RESPONSE AUDIOMETRY(ERA):

Fairly reliable to determine cochlear and retrocochlear hearing loss. Whenever the sound isintroduced to the ear it stimulates

- The cochlea- Auditory nerve- Brain steam- Brain

It produces the electrical potentials in these organs

these evoked potentialsare measured and plotted.

Electrocochleography : Measurement of electricactivity in the cochlea.

Brain steam evoked response audiometry (BERA):Brain steam electric activity is measured.

Cortical evoked response audiometry( CERA):Measurement of cortical activity after soundstimulation.

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Vestibular function test

Nystagmus : Involuntary rhythmic movement of the

eyeballs.

Physiological ( i.e. occurs on extreme lateralgaze )

Pathological :

A. Central type: In any direction orvariable (CNS lesions,

cerebral , cerebellardiseases & with drugs ).

B. Ocular: Pendular n.

C. Vestibular n : Horizontal type.

Slow component isusually towards the

diseased side.