24 Examination of the Ear
There is no doubt that you will be asked to assess an ear in a clinical ear, nose, throat (ENT) examination. Time taken in practising your technique is therefore well spent. It is not just a question of spotting clinical signs or a disease process. The examiner will want to establish that you have an orderly and thorough technique, and that you are able to present your findings accurately and clearly. You will be asked how you would manage the patient, so be thinking about this as you present your examination findings. The common topics will include a patient with hearing impairment, otorrhoea, otalgia, tinnitus, vertigo, facial palsy or a combination of these. A methodical approach will impress the examiners, but a clumsy cluttered technique is likely to depress you and them.
Be bare below the elbows and make sure that you wash/clean your hands before every patient. This is mandatory in clinical practice and it is imperative you are seen to do so in the clinical examination. Be polite with the patient, make sure that you clearly introduce yourself before starting the examination and explain what it is that you have been asked to do. Ask which is the better hearing ear. Always begin the examination with the better ear and never touch the patient before asking if there is any tenderness. The ear should be examined with an electric powered head light and the ear canal and tympanic membrane with an otoscope or microscope. The patient should be seated sideways to the surgeon, who sits opposite the ear to be examined and reflects light onto it.
Examine the pinna in front and behind for signs of inflammation or skin lesions. The mastoid process should be carefully examined for scars, redness or tenderness. Be particularly careful not to miss a fading post-auricular or endaural scar or a pre-auricular pit/sinus. Note any discharge from the external auditory meatus as well as any inflammation of the skin. Common examination subjects include congenital lesions of the pinna (e.g., microtia, which may be associated with an ossicular chain discontinuity), cauliflower ears, perichondritis and surgical scars.