Ear Exam







-  Seated



-  Mouth vs nose breathing

-  Nasal voice

-  Ear position, size, shape, symmetry

-  Low set ears: chromosol abnormality (Downs syndrome..)

-  Scars, lesions, masses

-  Tophi esp tip: Gout

-  Pigmented lesions: SCC, BCC..

-  Otorrhoea: perforation (otitis media..), otitis externa

-  Mastoid/parotid swellings: sternomastoid tumour

-  Pharynx & tonsils

-  Otoscopy



-  Lymph Nodes: pre & post auricular

-  Lymphadenopathy: otitis externa

-  Tragus tenderness: otitis externa

-  Mastoid tenderness: otitis media, mastoiditis

-  Maxillary sinus tenderness: sinusitis



-  Mastoid process tenderness: otitis media



-  Whisper

-  Formal testing

-  Deafness, presbycusis, hyperacusis

-  Tuning fork testing: Rhine, Webbers







-  Examine normal ear first

-  Pull pinna posterio-superiorly





-  Cerumen build up

-  Otoetoma: cold weather swimming, etc.

-  Tympanic Membrane

-  Patency of tympanic membrane: perforation, cerumen, foreign body

-  Tears, scar tissue: prev perforation

-  Ossicular dislocation (from head trauma)

-  Erythema, dullness: otitis media

-  Meniscus: otitis media w effusion

-  Grommets: chronic otitis media

-  Cholesteotoma






Tuning Fork Hearing Testing <Up>


Rhinne Test:

-  Struck tuning fork placed on mastoid, when no longer heard placed by ear

-  Normal: air conduction > bone

-  Conductive loss : bone > air

-  Sensorineural loss: both impaired


Weber Test

-  Struck tuning fork placed in center of forehead

-  Pt reports where sound best heard

-  Normal or both ears effected --> center

-  Unilat. Conductive loss --> loudest effected side

-  Unilat. Sensorineural loss --> loudest unaffected side

-  ie: loudest in left ear --> left conductive or right sensorineural loss


Weber & Rhinne