ear examination

Ear examinations include general examination of the ear, eustachian tube examination, middle ear and mastoid examination, hearing examination, and vestibular function examination. The ear condition is determined by the above five examinations. For the general physical examination, according to the first right and left left order examination, first check the ear with a lighter condition and then check the condition to focus on the ear to avoid cross infection. Basic Information Specialist Category: Otolaryngology Examination Category: Other Inspections Applicable gender: whether men and women apply fasting: not fasting Tips: Clean your ears before checking to facilitate inspection. Normal value 1, voice test: normal whispers can be heard at a distance of 6m. 2. Table test: The recording method is expressed by the ear listening distance (cm) / the standard listening distance (cm) of the watch, and the small number indicates good hearing. 3, tuning fork test: normal hearing, Linna test air conduction > bone conduction (+). Weber test: center. Schwabbaine test: normal (equal). 4. The cochlear electrogram SP does not increase, and the SP/AP ratio is <0.4. 5. The hearing range of normal people is between 0 and 25 decibels (dB). 6, the eustachian tube is smooth. 7. The angiography is normal, the soft tissue density is uniform, the mastoid height is normal, and the small bone, bone, upper tympanic cavity, etc. are not damaged. 8. There is no pain in the ear and the hearing is good. Clinical significance Abnormal result 1. Voice test: The whisper is shortened to 4m, indicating mild deafness, 1m is moderate deafness, and shorter than 1m is severe and complete deafness. 2. Table test: The recording method is expressed by the ear listening distance (cm)/the standard listening distance (cm) of the watch, and the number may be bad. 3, the judgment of the tuning fork test results a, conductive 聋: Linna test, air conduction <bone conduction (a) air conduction = bone conduction (+). Weber test: biased to the ear or heavier ears to the ear or lighter ears. Schwabbaine test: extended (+). b, sensorineural hearing loss: Linna test, air conduction > bone conduction (both shorter than normal) (short +). Weber test: or lighter ears. Schwabbaine test: shortened (+). c. Mixed 聋: Linna test (+), (-) or (±). Weber test: uncertain The Schwabbaine test was shortened (+). 3, pure tone hearing threshold test a, conductive 聋: bone conduction curve is normal or close to normal, air conduction curve hearing loss is between 30 ~ 60dB, generally low frequency hearing loss is heavier. b. Sensorineural hearing loss: The hearing curve is gradually decreasing or steeply descending, and the high-frequency hearing loss is heavier. The bone conduction curve and the air conduction curve are close to each other or coincide with each other. c. Mixed sputum: The bone conduction curve decreases, and the air conduction curve is lower than the bone conduction curve. 4. Listen to the electric reaction side a. The diagnosis of Meniere's disease "-SP" is increased, so that the ratio of -SP/AP is greater than the upper limit of the normal range (≥0.4 or =0.45), the SP-AP complex is broadened, and the polarity of SP and AP is opposite. AP is negative and SP is positive. b. Sensory hearing loss SP is difficult to identify. The CM threshold is obviously improved or the maximum stimulation intensity is still not revealed. The disappearance of CM is an important feature of sensorineural hearing loss. c, neurological hearing loss AP can disappear, CM is normal or roughly normal. d, the advantage of auditory neuropathy - SP (SP / AP > 0.4), -SP is multi-peak, SP-AP complex waveform widened, AP amplitude decreased or disappeared. (SP is the sum potential and AP is the auditory nerve complex potential) 5. Check the eustachian tube obstruction during the eustachian tube examination. 6, the external auditory canal wall has foreign bodies, redness, swelling, stenosis, etc., auricle deformity and tenderness, perforation of the tympanic membrane. 7, the ear feels up and blockage, hearing loss or tinnitus is otitis media. Need to check the population of otitis media, patients with otitis media, hearing impairment, patients with eustachian tube dysfunctional otitis media, otitis externa, tympanic membrane perforation. Precautions Taboo before inspection: 1. Clean your ears before inspection to facilitate inspection. 2, remove the inspection site clothing including underwear with metal materials and various items: such as headwear, hairpins, earrings, necklaces, jade, coins, belts and keys. 3, if CT enhanced scan or children, unconscious, need to be accompanied by healthy people. 4, CT enhanced scan If you use ion contrast agent, you need to do intravenous injection of contrast agent iodine allergy test, no response after 20 minutes, before examination. 5, 1 week, do not accept drugs containing heavy metals, do not do gastrointestinal tincture examination. Patients who have been tested for expectorant need to wait for the sputum to empty; if they are eager to have a CT examination, they should be treated with a cleansing enema or oral laxative to sputum. Taboo when checking: 1. If you have a cold, other diseases such as tonsils, tell your doctor. 2, the head should not be tampering, because the otoscope opening is smaller than the tympanic membrane, so the otoscope should keep moving the otoscope to see the whole tympanic membrane, otherwise you can only see a part of the tympanic membrane. When the otoscope is inserted, reaching the junction of the cartilage and the bone can cause pain and cough reflex. Keep a certain luminosity for inspection. 3. In a quiet environment. 4. During the speech test, the examiner pays attention to the consistency of each pronunciation, the vocabulary is easy to understand, the pronunciation is accurate and clear. Be careful not to let the examinee see the examiner's lips. 5. Select the tuning fork of the appropriate frequency when tuning the fork. Tap the tuning fork in a certain way. The tuning fork is placed in the correct position during the test. The fork of the tuning fork does not touch the fork, and the fork does not touch the hair. 6. Prevent hearing fatigue. 7. When the watch is tested, the stopwatch should be on the plane of the external auditory canal. Inspection process First, the ear general inspection Clinical mainly includes external ear examination and tympanic examination. For the general physical examination, according to the right-to-left and left-left examination, the patient's words should first check the ear with a lighter condition and then check the condition and focus on the ear to avoid cross-infection. Second, the Eustachian tube inspection method mainly has three methods: 1. Pinch the nose and suffocate the method. After the patient inhales, use your fingers to pinch the nostrils on both sides, close the mouth, and forcefully exhale from the nose to make the pharyngeal air rush into the Eustachian tube. 2. The balloon blowing method means that the patient's mouth contains water. The olive head of the eustachian tube is inserted into the pupil of one side of the patient, and the other side of the nose is pressed with the finger. When the water is swallowed, the sphere is pressed and the air is pressed. Can be flushed into the eustachian tube. 3. Catheter blowing method, that is, the patient takes a seat, after cleaning the nasal secretions, the elbow tube catheter elbow is inserted slowly down the bottom of the nose, reaching the posterior wall of the nasopharynx, then turning to the outside 90°, then slightly pulling forward , the catheter is slid over the bulge and into the mouth of the eustachian tube. Fix the catheter, inject air through the catheter with a blown ball, and listen to the ear with auscultation to check whether the Eustachian tube is patency or not. Third, the hearing test method is mainly the following eight methods: 1. Voice test: In a quiet environment longer than 6m, the ground draws a distance mark. The patient stands 6m away from the examiner, but the body can't be too close to the wall to avoid sound interference. The ear to be inspected is facing the examiner, and the other ear is blocked with a cotton ball or finger and closed, so as not to see the examiner's lip movement affecting the accuracy of the examination. The examiner uses the residual air in the airway to emit 1 or 2 syllables first. Vocabulary, 嘱 patients repeatedly say that they hear the vocabulary, should pay attention to the consistency of each pronunciation, the vocabulary is easy to understand, the high and low sounds are used together, the pronunciation is accurate and clear. 2. Table test: the patient is seated, closed, and the non-inspected side ear canal is fastened with a finger. The examiner stands behind the patient, and after familiarizing the patient with the test sound, the stopwatch is placed on the plane of the external auditory canal. The test just heard the distance from the ear to the ear. The recording method is expressed in the ear listening distance (cm) / the standard listening distance (cm) of the watch, such as 100/100 cm, 50/100 cm. 3. Whisper inspection method: carried out in a static room of 6m length. The common vocabulary is spoken in whisper intensity, and the distance that the test ear can hear is recorded and compared with the normal ear (test ear hearing distance/normal ear listening distance). 4. Tuning fork examination method: The tuning fork is placed about 1cm away from the ear canal, and the listener is "air conduction"; the person who is placed on the skull is "bone conduction". It is the most common method for identifying the nature of deafness. Commonly used C octave five sets of tuning forks, the vibration frequency is 128, 256, 512, 1024, and 2048Hz. 5. Pure tone hearing threshold test includes air conduction and bone conduction test. The air conduction test starts from 1KHz. After the patient hears the sound, it will drop down every 5dB, until it can't be heard, then increase the sound intensity (5dB per file), and repeat the test until the test. Until the exact hearing threshold. Then, in the same way, the hearing thresholds of other frequencies are sequentially tested. Attention should be paid to the use of intermittent sounds to avoid hearing fatigue. The bone conduction test operates in the same way as the air conduction test. 6. Electrical reaction audiometry uses the superposition average technique to record the acoustic evoked potentials of the auditory system, determine the functional status of the auditory system, and analyze certain diseases of the otology and neurology. At present, there are mainly cochlear electrograms, auditory brainstem responses and mid-latency reactions. 7. Otoacoustic emission examination: Clinically recommended use of transient acoustic evoked otoacoustic emissions (TEOAE) and distorted product otoacoustic emissions (DPOAE) in induced OAE. Inducible otoacoustic emission can be used for neonatal hearing screening, which is simple and rapid. Those who have a positive OAE response can be judged as normal peripheral hearing; combined with auditory evoked potential examination can identify cochlear and post-cochlear auditory system lesions. 8. Acoustic impedance measurement: The basic test items are: tympanic plane static acoustic value measurement, tympanogram and sacral muscle reflex test. Fourth, the mastoid group should use CT scan. 5. The middle ear examination is mainly divided into three parts: Otoscopy: The middle ear mucosa can also be observed through the tympanic membrane hole. Whether there is chronic granulomatous tympanitis on the tympanic membrane of the genus, whether the external auditory canal is narrow or curved, should also be observed. If you can notice the above points during otoscopy, it will be very helpful for treatment. Hearing test: Early or several cases with conductive hearing impairment, severe or long-term cases, there are mild to severe mixed hearing impairment, and more serious may also be full. X-ray examination: Most chronic otitis media is a sequela of repeated otitis media in children, so most of the mastoid gasification is poor. A small number of mastoid gasification is good, mostly tympanic membrane long-term cavernous otitis media, or chronic otitis media caused by trauma and talent. Sixth, vestibular function test The vestibular function test is based on a series of symptoms produced by the vestibular system, or by some methods to stimulate the vestibular system, to observe the induced nystagmus, dumping, vertigo and autonomic nervous system response to identify the nature of the lesion, Degree and location. Not suitable for the crowd Not suitable for checking the crowd: 1, allergic constitution or ionic contrast agent allergy history (such as the use of ion-type contrast agents also need to do iodine allergy test), infants and elderly patients over 60 years old. 2. For patients with hearing loss between 1000 and 4000 Hz of 40-50 dB, it is not suitable for cochlear electrograms. The ears are the same on both sides. 3, nasal and nasopharynx have acute inflammation, nasal and nasopharynx have purulent secretions. Adverse reactions and risks Nothing.

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