Hearing impairment physical examination
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Overview
Physical exam along with history aid in the definitive diagnosis of hearing loss. Physical exam tests, such as the finger rub and whisper tests and some other methods as described below, abnormities in these tests help guide diagnosis.
Physical Examination
Ear[1]
- Weber’s tuning fork testing
- Rinne’s tuning fork testing
- Finger rub
- Whisper test
- Handheld audiometer
- Mobile apps and smartphones audiometer
| Finger rub | Whisper test | Handheld audiometer | Mobile apps and smartphones audiometer | Weber’s tuning fork testing | Rinne’s tuning fork testing |
|---|---|---|---|---|---|
| Examiner softly rubs two fingers together close to the patient’s ear. |
Examiner stands at arm’s length approximately 24 inches, behind the patient. The patient blocks 1 ear himself. Examiner whispers 5-6 letters/number combinations. |
Examiner holds audiometer inside patient’s ear one at a time. Patient indicates awareness of each tone. | The advancement of science has led to the development of mobile technology-based screening options, such as the use of different mobile apps (for example, uHear, Mimi) and smartphone or tablet-based portable audiometers that can be connected to perform screening for hearing impairment. | Strike a tuning fork and place it on the middle of the forehead. A
normal test produces sound on both sides (no lateralization). |
Strike a tuning fork and place it on the mastoid bone behind the ear. When the patient indicates no further sound, move the still-vibrating
fork to the ear. In a normal test, the patient will still hear air-conducted sound (air conduction will be better than bone conduction). AC > BC |
| A positive result is a failure to identify rub in two or more than two times of 6 attempts. | The positive result is failure to repeat ≥3 of the 6 combinations | Positive result is failure to identify either the 1000- or 2000-Hz frequency in both ears or the 1000- and 2000-Hz frequencies in 1 ear. | They generally require special supra-aural headphones for monitoring. | In unilateral
conductive loss, the sound will be greater in the affected ear. In sensorineural hearing loss, the sound will lateralize to the better-hearing ear. |
With conductive loss, the patient will not hear the air-conducted sound. This AC< BC. |
- Abnormalities of the tympanic membrane on inspection, such as scarring suggest a history of middle ear disease, and a visible perforation or cerumen impaction may suggest conductive hearing loss.
References
- ↑ Nieman CL, Oh ES (2020). “Hearing Loss”. Ann Intern Med. 173 (11): ITC81–ITC96. doi:10.7326/AITC202012010. PMID 33253610 Check
|pmid=value (help).
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