Investiagtions for hearing in adults ?
first thing is to exclude impacted ear wax and acute infections
Investigations for hearing in children?
AOAE is done as part of new-born hearing screen
- ideally in children hearing should be checked within the first 4-5weeks
9/12 - 1.5yrs = ‘distraction testing’
4-5yrs = ‘conditioned ausitory response’
audiological assessment referall
- sudden loss of hearing = Immediate ENT
- if more than 30days = 2wwr ENT
rapid hearing loss - ENT/Adio-vestibular medicine
Pure tone audiogram
What is tympanometry?
Tympanometry refers to a test that helps in the evaluation of the proper functioning of the middle ear.
The test seeks to establish the condition and movement of the tympanic membrane as it responds to changes in pressure
Tympanometry classifications?
Type A = normal movement of TM
Type B = little or no TM movement - possible fluid in middle ear
Type C = middle ear has negative pressure
- ?retracted eardrum
- ?blockade of eustachian tubes
What is flexible rigid fiberoptic nasopharyngoscopy?
What are its uses?
FNE is a diagnostic prodcedure used to visualise the anterior notstrils, through postnasal space into the upper airwarys to the epiglottis and vocal cords
- often used in the investiagtions of foreign bodies, polpys and malignancy
What is microsuction? What is it used for?
microsuction is a cleaning procedure for the ear.
aural microsuction is commonly performed to removed impacted wax, discharge or foreign bodies
What is lymph node biopdy?
US-guided FNA can be used to get a sample from a neck lymph node or from a thyroid nodule
When is XR used in ENT?
- lateral neck XR can be used in cases of suspected FB in the throat
When in CT used in ENT?
- allows visualisation fo soft tissue and bony structures
- visualise possible sinus disease
- iodine contrast - abnormal blood flow to lymph node enlargement and cancer
When is MRI used in ENT?
anatomical definition provides better differentiation between normal or inflamed or neoplastic tissue
gadolinium contrast use - iodine should uo in areas of increased vascularity
When is contrast studies used in ENT?
when assessing swallowing using barium swallow as well as pharyngeal webs and pouches
When is US used in ENT?
particularly used for swelling of the head and neck area
also used to guide fine needle aspiration
Indications for Ear swabs?
rarely done in general practice - can be useful if tx failure in Otitis externa or if recurrent
can also be useful if effusion leaks into external auditory canal secondary to a TM perforation
Indications for nasopharyngeal swabs?
flu, covid19, RSV, whooping cough, meningitis and MRSA
Indications for throat swabs?
not routinely done
- concerned about rare cause of STI or diphtheria
- concerned about scarlett fever
When is Dix-hallpike manoeucre used?
to assess whether pt has BPPV
- turn pts head to one side at 45°
- lay them down flat quickly
- observe for any nystagmus for at least 30s
- repeat on the other side
When is the Epley manoeuvre used?
used to treat BPPV
- have pt lying flat and just off the edge of bed
- turn head 90° and hold fro 30s
- rotate pt to their side and rotate head so theyr’re facing the floor, hold 30-60s
- sit up pts maintaining sideways position
- once upright, realign head to midline
What Investigations are done in suspected acute otitis media?
usually a clinical diagnosis
if perforated with visible discharge - can do ear swb
- usually only in recurrent cases or if tx fails
What Investigations are done in suspected cerumen impaction?
usually clinical diagnosis aided with otoscopy
What Investigations are done in suspected Labrynthitis?
usually a clinical diagnosis
What Investigations are done in suspected otitis externa?
clinical diagnosis with otoscopy
ear swab - usually not required but can be used to find out causative organism
What Investigations are done in suspected malignant otitis externa?
CT scan of head
sometimes MRI head
What Investigations are done in suspected BPPV?
clinical diagnosis with +ve dix-hallpike - rotatory nystagmus
What Investigations are done in suspected meniere’s disease?
clinical diagnosis
- vertigo, hearing loss and tinnitus
- aural fullness/pressure
