Clinical Examination of Ear for Medical Students

Clinical Examination of Ear for undergraduate and post graduate students.

Assalamu Alaikum, my name is Dr. Akbar Abbas, and today I will be walking you through a detailed ear examination process.

Step 1: Initial Inspection of the Ear

We will begin by inspecting the outer ear, looking for:

• Any scarring
• Swelling around the ear canal
• Discharge from the ear canal
• Signs of previous surgeries

Step 2: Palpation

Next, I will gently palpate the pinna (outer ear) and the tragus to check for tenderness, swelling, or any abnormal findings.

Step 3: Otoscopic Examination

Using a metallic ear speculum, I will carefully examine the ear canal under direct vision to assess:

• The presence of ear wax or discharge
• The integrity of the tympanic membrane (eardrum)
• Signs of perforation or infection
• The cone of light reflection, which is a healthy sign of a normal eardrum

We will repeat the same procedure on both ears, switching hands accordingly for the right and left ears.

For more about otoscopic techniques, visit BMJ Best Practice: Otoscopic Examination.

Step 4: Basic Hearing Tests

Whisper Test

The patient will cover one ear. I will whisper simple words into the other ear for the patient to repeat. This helps assess hearing clarity.

Friction Test

With one ear covered, I will rub my fingers near the open ear canal. The patient will confirm if they hear the sound.

Step 5: Tuning Fork Tests

We will use a 512 Hz tuning fork, which is standard in clinical hearing assessments.

Rinne Test

The tuning fork will be placed behind the ear (mastoid bone) and then in front of the ear canal to compare air conduction vs. bone conduction. Normally, air conduction should be better.

Weber Test

The vibrating tuning fork will be placed at the center of the patient’s forehead. The patient should hear the sound equally in both ears if no hearing loss is present.

Learn more about these tests from Johns Hopkins Medicine – Rinne and Weber Tests.

Step 6: Absolute Bone Conduction Test

This comparative test evaluates sensorineural hearing loss between the examiner and the patient by placing the vibrating tuning fork on the mastoid bone.

Step 7: Facial Nerve Examination

To assess the facial nerve (cranial nerve VII), the patient will:

• Raise their eyebrows
• Close their eyes tightly while I try to open them
• Puff their cheeks
• Show their teeth

These movements help detect any facial muscle weakness.

For a deeper understanding, read Cleveland Clinic’s Overview of Facial Nerve Palsy.

Step 8: Cerebellar Function Tests

Gait Test

The patient will be asked to walk in a straight line with eyes open and then closed to assess balance.

Romberg’s Test

The patient will stand with feet together, first with eyes open and then closed. Swaying or imbalance upon closing the eyes may indicate cerebellar dysfunction.

Learn more about the Romberg Test from MedlinePlus.

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Conclusion

This comprehensive ear and neurological exam helps in diagnosing:

• Conductive and sensorineural hearing loss
• Middle and inner ear pathologies
• Facial nerve impairments
• Cerebellar disorders

For regular check-ups or if you are experiencing symptoms like ear pain, hearing loss, or balance issues, please consult a qualified ENT specialist.

Thank you for trusting Dr. Akbar Abbas for your ENT care!

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Stay informed and prioritize your health.

This educational video is for students and patients to make informed decisions about their own and others’ health. Dr Akbar Abbas, one of the best ENT specialists in Karachi, Pakistan. He specializes in otolaryngology, cochlear implants, and ear surgery and is one of the few experts on pituitary and head and neck cancer surgery in Pakistan. Presently serving at Aga Khan University Hospital.