What is an ear examination?
Your doctor will perform an ear examination, or otoscopy, if you have:
an ear infection
ringing in your ears
any other ear-related symptoms
Your doctor can examine your ear to diagnose an ear infection or to see if treatments for an ear condition are working. Ear infections are common, especially in children.
Why is an ear examination performed?
Your doctor may also perform an ear exam if you’ve had or are experiencing the following:
a head injury
chronic ear infections
a punctured eardrum
An ear exam may be slightly uncomfortable or painful if you have an ear infection. Your doctor will stop the exam and remove the otoscope if the pain worsens.
How is an ear examination performed?
Your doctor may dim the lights in the exam room to make it easier to see your ear canal and eardrum with an otoscope. An otoscope is a handheld light with a removable plastic tip shaped like a cone that allows the doctor to look inside your ear.
Your doctor will gently pull in the following directions to straighten your ear canal:
Then, they’ll place the tip of the otoscope into your ear and shine a light into your ear canal and down to your eardrum. They’ll carefully rotate the otoscope in different directions to see the inside of your ear and your eardrum.
Your doctor may use a pneumatic otoscope, which has a plastic bulb on the end, to blow a small puff of air against your eardrum. Normally, this air will cause your eardrum to move. Your doctor will see little or no movement if you have an infection and fluid buildup behind your eardrum.
Young children will be asked to lie on their backs with their heads turned to the side to allow the doctor to examine one ear at a time. Older children and adults can sit up, tilting their heads to the side to allow the doctor to examine each ear.
You can purchase an otoscope to check your child’s ears at home if you think they may have an ear infection. Contact their doctor right away if you see any of the following in your child’s ears:
Video otoscopy is the use of a short, rigid endoscope that uses a video camera to transmit images to a larger screen for magnification. In order to illuminate the ear canal, the scope contains fibre optics that transmit a bright light. Video otoscopes also contain a working channel, allowing instruments and irrigation in order to obtain samples from deep in the ear canal as well as to remove debris in the ear canal.
The video otoscope is useful in diagnosing and treating ear infections and growths inside the ear. Utilizing the irrigating function on the video otoscope, the doctor can remove debris that may be deep in the ear canal. Thus, the video otoscope is valuable in many ways: it allows deep ear cleaning (removing debris adhered deep in the ear canal); it allows flushing/cleaning behind a ruptured eardrum; and it allows for diagnosing, biopsying, and removing tumours in the ear canal.
Benefits of video otoscopy deep ear procedures are that it is typically the safest, most cost-effective and best method to diagnose and treat serious ear diseases.
Audiometry is a branch of audiology and the science of measuring hearing acuity for variations in sound intensity and pitch and for tonal purity, involving thresholds and differing frequencies
What Is Audiometry?
Hearing loss comes with age but can affect anyone. According to a study in American Family Physician, at least 25 percent of people over 50 experience hearing loss, and 50 percent of people over 80 experience it. One way to test for hearing loss is through the use of audiometry.
An audiometry exam tests how well your hearing functions. It tests both the intensity and the tone of sounds, balance issues, and other issues related to the function of the inner ear. A doctor who specializes in diagnosing and treating hearing loss called an audiologist administers the test.
The unit of measure for sound intensity is the decibel (dB). A healthy human ear can hear quiet sounds such as whispers. These are about 20 dB. A loud sound such as a jet engine is between 140 and 180 dB.
The tone of a sound is measured in cycles per second. The unit of measure for tone is Hertz (Hz). Low bass tones measure around 50 Hz. Humans can hear tones between 20-20,000 Hz. Human speech generally falls in the 500-3,000 Hz range.
Why Audiometry Is Performed?
An audiometry test is performed to determine how well you can hear. This may be done as part of a routine screening or in response to a noticeable loss of hearing.
The common causes of hearing loss include:
chronic ear infections
inherited conditions, such as otosclerosis, which occurs when an abnormal growth of bone prevents structures within the ear from functioning properly
an injury to the ear
inner ear diseases, such as Ménière’s disease or an autoimmune disease that affect the inner ear
regular exposure to loud noises
a ruptured eardrum
Damage to the ear or exposure to loud sounds for a long period can cause hearing loss. Sounds louder than 85 dB, such as you hear at a rock concert, can cause hearing loss after only a few hours. It’s good to use hearing protection, such as foam earplugs, if you’re exposed to loud music or industrial noise on a regular basis.
Sensorineural hearing loss occurs when hair cells in the cochlea aren’t working properly. The cochlea is the part of the ear that translates sound vibrations into nerve impulses to be sent to the brain. Sensorineural hearing loss can also occur due to damage to the nerve that carries sound information to the brain or damage to part of the brain that processes this information. This type of hearing loss is usually permanent. It can be mild, moderate, or severe.
Impedancemetry is an important examination for the evaluation of the ear’s health and is recommended by the specialist during an ENT visit when there is a suspect hearing impairment.
Impedance audiometry is an objective method based on the measurement of the pressure in the middle ear, stapedius reflexes, and tension of the tympanic membrane. It is one of the most common and most accurate methods for testing the middle ear.
Impedance audiometry covers the following tests:
tympanometry, which measures the pressure in the middle ear
measuring the reflex of the stapedius
Eustachian Tube Function Test
Basically, this test assesses the patency of the middle ear. This study is very helpful for the diagnosis of:
presence of infectious fluids in the middle ear
otitis media with effusion
hypertrophy of adenoids or tonsils
Eustachian tube dysfunction
ossicular chain fracture
How is the impedance audiometry performed?
Impedance audiometry is completely painless and non-invasive, but it requires small mobility during the measurement. It involves inserting the probe tube into the ear. The Tube is ended with a cap matched to the size of the ear. The probe’s cap is inserted approximately 3-5 mm into the ear canal.
Tympanometry is based on measuring the acoustic resistance and pressure in the middle ear. Tympanometry is performed by changing the pressure in the external auditory canal to obtain such pressure that prevails in the middle ear. This causes the impedance of the middle ear to be the smallest, and the compliance of the tympanic membrane is the greatest.
Stapedius reflex test is performed automatically, by providing middle and high-frequency stimulus sounds (500, 1000, 2000 and 4000 Hz).
Eustachian tube patency test involves inserting a tympanometer probe in the ear canal. It’s the output pressure in the tympanic cavity being tested. While the patient clogging his nose and swallowing saliva causes a negative pressure in the tympanic cavity, the ear pressure is measured again. The patient exhales while closing the mouth and clogging his nose, which causes a positive ear pressure generation. The last measurement of the pressure in the tympanic cavity is performed.
Depending on the appearance and placement of the tympanometric curve middle ear is evaluated as standard (Type-A), total occlusion (Type-B) or partial occlusion (Type-C). In B and C cases pharmacological treatment, physiotherapy or surgery is recommended.
Distortion Product Otoacoustic Emissions testing (DPOAE) DPOAE ae responses generated when the cochlea is stimulated simultaneously by two pure tones.
Your ear is made up of three parts—the outer, the middle, and the inner ear. The OAE test is used to find out how well your inner ear, or cochlea, works. It measures otoacoustic emissions or OAEs. These are sounds given off by the inner ear when responding to a sound.
There are hair cells in the inner ear that respond to sound by vibrating. The vibration produces a very quiet sound that echoes back into the middle ear. This sound is the OAE that is measured.
If you have normal hearing, you will produce OAEs. If your hearing loss is greater than 25–30 decibels (dB), you will not produce these very soft sounds.
This test can also show if there is a blockage in your outer or middle ear.
If there is a blockage, no sounds will be able to get through to the inner ear. This means that there will be no vibration or sounds that come back.
How the OAE Is Done
A small earphone, or probe, is placed in your ear. The probe puts sounds into your ear and measures the sounds that come back. You do not need to do or say anything during the test. The person doing the test can see the results on the monitor screen.
The purpose of Vestibular Function Tests (VFTs) is to determine the health of thevestibular portion of the inner ear.
Vestibular system diagnosis
A link between your inner ear and your brain helps you keep your balance when you get out of bed or walk over rough ground. This is called your vestibular system.
If a disease or injury damages in this system, you can have a vestibular disorder. Dizziness and trouble with your balance are the most common symptoms, but you also can have problems with your hearing and vision.
The vestibular system provides a sense of balance and the information about body position that allows rapid compensatory movements in response to both self-induced and externally generated forces. The peripheral portion of the vestibular system is a part of the inner ear that acts like a miniaturized accelerometer and inertial guidance device, continually reporting information about the motions and position of the head and body to integrative centers located in the brainstem, cerebellum, and somatic sensory cortices.
Although we are normally unaware of its function, the vestibular system is a key component in both postural reflexes and eye movements. If the system is damaged, balance, control of eye movements when the head is moving, and a sense of orientation in space are all adversely affected. These manifestations of vestibular damage are especially important in the evaluation of brainstem injury.
The circuitry of the vestibular system extends through a large part of the brainstem, and simple clinical tests of vestibular function can be performed to determine brainstem involvement, even on comatose patients.
Testing for Vestibular and Balance Disorders Electronystagmography/Videonystagmography (ENG/VNG) Rotation tests Video head impulse testing (VHIT) Vestibular evoked myogenic potential (VEMP).