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Pain Location, quality, course, aggrevating/relieving factors
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Discharge (frequency, colour, consistency, odour)
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|
Feeling of fullness/pressure
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Hearing loss (uni/bilateral/partial/complete
|
|
Tinnitus
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Vertigo
|
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Loud noise exposure
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Injury to the ear
|
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Recent swimming/air travel
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Infection
|
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Past Ear surgery/treatment
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Past serious illness
|
|
Family history of hearing problems/ ear conditions
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Cold water sports
|
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Types
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Age
|
|
Congenital
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Infant - Young children
|
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Serous Otitis Media
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Infant - Young children
|
|
Postinfective
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Young children - Teenagers/adolescents
|
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Noise Induced
|
Teenagers/adolescents - Over 60
|
|
Otosclerosis
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20-60yo
|
|
Acoustic Neuroma
|
20-60+yo
|
|
Meniere's Disease
|
20-60 yo
|
|
Early Prebycusis
|
40-60 yo
|
|
Prebycusis
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60+
|
|
Subjective
|
Objective
|
|
Most common
|
Can be heard by patient and examiner - Rare
|
|
Sound can only be heard by patient - caused by abnormal activity in inner ear/CNS
|
Vascular Abnormalities, muscle related
|
|
Primary
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Secondary
|
|
Idiopathic + sensorineural Hearing loss
|
Underlying cause - not sensorineural
|
|
Infections
|
Ear wax
|
|
Inner ear noise damage
|
Meniere's disease
|
|
Otosclerosis
|
Acoustic Neuroma
|
|
MS
|
Ototoxic drugs
|
|
Metabolic disorder
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Psychological disorders
|
|
Mechanical disorders
|
|
|
External Ear
|
Auscultate periauricular area, temporal bone, orbit, vascular structures of the neck
|
|
Otoscopy
|
TMD Exam
|
|
CN Exam (VII, VIII)
|
Check for anaemia, thyroid, hyperlipidemia +diabetes
|
|
Assess for other causes of pain, tinnitus/hearing loss
|
Regional lymphnodes
|
|
If Tinnitus is pulsatile - head, neck exam, blood pressure + CV system (Murmurs, carotid + temporal artery bruits
|
|
|
EMERGENCY REFERRAL
|
|
Sudden onset pulsatile tinnitus
|
|
Tinnitus with associated significant neuro symptoms
|
|
Tinnitus Secondary to head trauma
|
|
Tinnitus associated with sudden hearing loss
|
|
Objective/pulsatile tinnitus
|
|
Unilateral tinnitus
|
|
Tinnitus with unilateral/asymmetric hearing loss
|
|
Tinnitus with persistent otalgia/otorrhoea that does not resolve with treatment
|
|
Tinnitus with vestibular symptoms -dizziness, vertigo
|
|
Tinnitus of unknown cause - not associated with hearing loss, ear pain, drainage or malodour, vestibular symptoms or facial weakness or hearing loss that cannot be distinguished
|
|
Tinnitus that is causing distress - despite primary care management
|
|
Before inserting Otoscope, observe the outside of the ear - hearing aid, shape, discharge, deformities, skin
|
|
|
Pull the pinna up and back for adults, up for children
|
|
|
Slowly insert no more than 0.5cm in
|
|
Acute Otitis media
|
S&S
|
Otoscopy Findings
|
|
Fullness in the ear
|
Retracted, pink/red tympanic membrane
|
|
|
Fever
|
Pus and membrane can bulge
|
|
|
Vomiting
|
||
|
Headache
|
||
|
Hearing loss
|
||
|
Fluid coming from the ear
|
||
|
Diarrhoea
|
||
|
Serous Otitis media
|
||
|
Fullness, pressure, popping in the ear
|
Retracted Tympanic membrane - yellowish/blueish in colour
|
|
|
Hearing loss
|
Bubbles/ air/fluid level can be seen
|
|
|
Pain
|
||
|
Chronic suppurative otitis media
|
Painless otorrhea
|
Defects in tympanic membrane
|
|
Bacterial or fungal
|
Ear full of pus
|
|
|
Perforated Eardrum
|
Painful
|
|
|
Hearing loss
|
Hole in eardrum with redness
|
|
|
Caused by: Repeated infections + trauma
|
||
|
Exostosis
|
Surfer's ear - cold water
|
Nodular bony outgrowths covered with skin
|
|
Can occlude ear canal
|
||
|
Tympanosclerosis
|
Hearing loss if affects ossicles
|
White plaques in tympanic membrane /middle ear cavity
|
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