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Clinical Tests for Hearing and Tests of Eustachian Tube Function

Clinical Tests for Hearing and Tests of Eustachian Tube Function. Dr. Vijayalakshmi S. Tuning Fork (Gardiner Brown). Parts: Prongs or tines Shoulder Stem or handle Base or footplate. Tuning Forks. Frequencies used in E.N.T.: 256, 512, 1024 Hz

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Clinical Tests for Hearing and Tests of Eustachian Tube Function

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  1. Clinical Tests for Hearing and Tests of Eustachian Tube Function Dr. Vijayalakshmi S

  2. Tuning Fork (Gardiner Brown) Parts: • Prongs or tines • Shoulder • Stem or handle • Base or footplate

  3. Tuning Forks Frequencies used in E.N.T.: 256, 512, 1024 Hz • 128 Hz → produces more of vibration sense • more than 1024→ short sound decay time

  4. Striking Surfaces Hard: Olecranon, radial styloid process, patella Soft:Thenar & hypothenar eminences, thick rubber strip Tuning fork is allowed to fall by its own weight Impact area is b/w proximal two-thirds & distal one-thirds of its prongs

  5. Rinne Test

  6. Rinne Test Duration comparison technique: Vibrating tuning fork kept on pt's mastoid Pt signals when sound ceases → Move vibrating tuning fork over opening of ear canal (2 cm away & axis parallel to it) → Patient indicates if sound is still heard

  7. Rinne Test Loudness comparison technique (better): Vibrating tuning fork kept on pt's mastoid Pt signals if sound is heard → Move vibrating tuning fork immediately over opening of ear canal → If sound is heard → patient asked which sound is louder

  8. Results of Rinne Test Better response: • sound heard longer or louder A.C. > B.C. (positive test): • Normal hearing or Sensorineural deafness B.C. > A.C. (negative test): • Conductive deafness

  9. Rinne Negative • 256 Hz = 15 - 30 dB HL = mild conductive deafness • 512 Hz = 31 - 45 dB HL = moderate conductive deafness • 1024 Hz = 46 - 60 dB HL = severe conductive deafness

  10. Weber Test Procedure: Vibrating 512 Hz tuning fork placed in midline of pt’s skull at forehead / vertex / central incisor

  11. Results of Weber test Sound heard equally (central): • Normal hearing or B/L equal deafness Sound lateralizes to deafer ear: • Conductive deafness Sound lateralizes to better hearing ear: • Sensorineural deafness

  12. Why Weber lateralizes to deafer ear in Conductive HL ? 1. Lack of masking effect of surrounding noise on tuning fork sound, as air conduction is reduced in conductive deafness 2. Lack of dispersion of sound energy due to ossicular break

  13. Absolute Bone Conduction Test

  14. Absolute Bone Conduction Test • Pt's B.C. compared vs. examiner's normal B.C. • Vibrating tuning fork kept on pt's mastoid with pt’sE.A.C. occluded(to prevent A.C.) → pt signals when sound ceases → vibrating tuning fork kept on examiner's mastoid with examiner'sE.A.C. occluded

  15. Results of Absolute Bone Conduction Test Pt stops hearing before examiner: • sensorineural deafness Both hear for same duration: • normal hearing / conductive deafness

  16. Schwabach Test

  17. Schwabach Test Same as A.B.C. but E.A.C. is not occluded Pt stops hearing before examiner: • sensorineural deafness Both hear for same duration: • normal hearing Pt hears longer than examiner: • conductive deafness

  18. False Negative Rinne • Etiology:U/L severe Sensorineural deafness • Detection:Rinne negative, Weber lateralized to better hearing ear • Confirmation:A.B.C. reduced in deaf ear • Correction:Repeat Rinne test with masking of better ear with Barany's noise box

  19. False Negative Rinne Mechanism: In deaf ear, air conduction & bone conduction are absent.Trans-cranial transmission of sound to opposite cochleais perceived as I/L bone conduction. Reported as bone conduction > air conduction in deaf ear (Rinne Negative)

  20. Gelle Test • Vibrating tuning fork placed on pt's mastoid & examiner increases pt's E.A.C. pressure with Siegel's speculum Softer sound: • normal hearing or sensorineural deafness No change in sound: • conductive deafness

  21. Bing Test • Vibrating tuning fork placed on pt's mastoid & examiner blocks pt's E.A.C. Louder sound: • normal hearing or sensorineural deafness No change in sound: • conductive deafness

  22. Tests for E.T. function

  23. 1. Valsalva Maneuver Forced expiration with mouth & nose closed. Otoscopy shows lateral bulging of Tympanic membrane

  24. 2. Frenzel Maneuver • Hands free Valsalva for pilots • Compression of nasopharyngeal air by muscles of tongue • Otoscopy shows lateral bulging of tympanic membrane

  25. 2. Frenzel Maneuver

  26. 3. Toynbee Maneuver • More physiological • Swallowing with mouth & nose closed • Otoscopy shows retraction of tympanic membrane

  27. 4. Pneumatic otoscopy & Siegelization • Air pressure is alternately increased & decreased within external auditory canal • Mobility of tympanic membrane is observed • Normal mobility indicates good patency of Eustachian tube

  28. Siegelization

  29. Pneumatic Otoscope

  30. Normal Tympanic Membrane

  31. Eustachian Tube dysfunction

  32. Early otitis media with effusion

  33. Late otitis media with effusion

  34. Acute suppurative otitis media

  35. Ear drum perforation

  36. 5. Politzerization

  37. Politzer Bag

  38. 5. Politzerization • Rubber tube attached to a Politzer bag put into one nostril & both nostrils pinched • Patient asked to swallow or repeat “k” • Politzer bag is squeezed simultaneously • Otoscopy shows lateral bulging of ear drum in patent Eustachian tube

  39. 6. E.T. catheterization

  40. Eustachian tube catheter

  41. 6. E.T. catheterization • E.T. catheter passed along nasal floor till it touches posterior wall of naso-pharynx. • Catheter rotated 90° medially & pulled forward till it impinges on posterior nasal septum. • Catheter rotated 180° laterally, & its tip inserted into opening of E.T. • Politzer bag attached to outer end of catheter

  42. 6. E.T. catheterization Air pushed into E.T. catheter by squeezing Politzer bag. Examiner hears by Toynbee auscultation tube put in pt's ear. Blowing sound = normal E.T. patency Bubbling sound = middle ear fluid Whistlingsound = partial E.T. obstruction No sound = complete obstruction of E.T.

  43. 7. Tymapanometry

  44. 7. Tymapanometry • Type C = E.T. dysfunction • Type B = fluid in middle ear

  45. 8. William’s pressure equalization test • 200 mm H2O pressure is created in patient’s external auditory canal • Patient asked to swallow 10 times • Residual pressure in patient’s external auditory canal after 10th swallow is noted • Test repeated with -ve 200 mm H2O pressure created in patient’s external auditory canal

  46. William’s Test

  47. 9. Sono-tubometry • Sound made in pt’s nasal cavity & detected with stethoscope in patient’s external auditory canal • Loud sound = patent Eustachian tube 10. Eustachian tube Salpingogram • Dye instilled through E.T. catheter & X-ray taken 11. C.T. scan & M.R.I. of skull

  48. 12. Trans-nasal E.T. video-endoscopy 13. Test for E.T. patency in T.M. perforation • Saccharine crystal / antibiotic ear drop / methylene blue placed in middle ear via ear drum perforation. • Sweet taste / bitter taste / blue staining of secretions indicates patent Eustachian tube

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