Patient Assessment (HEENT)
Air conduction of hearing - ANS Normal first part of hearing pathway from the external ear through
middle ear
Sound waves travel through air and are transmitted from external and middle ear to the cochlea
Bone conduction of hearing - ANS An alternative pathway that bypasses the external and middle ear and
is used for testing purposes
A vibrating tuning fork, placed on head, sets the bone of the skull into vibration and stimulates the
cochlea directly
Sensorineural hearing phase - ANS Second part of hearing pathway involving the cochlea and cochlear
branch of CN VIII
Tug test - ANS if ear pain or discharge
Move auricle up and down and press on tragus
+ Tug Test in acute otitis
- Tug Test in otitis media
Mastoid process tenderness - ANS -Tenderness present with otitis media and mastoiditis
Normal TM description - ANS Pinkish gray color
Malleus lies behind upper part of the drum
Above the short process of the malleus lies the pars flaccida
Remainder of the TM is the pars tensa
From the umbo, the bright cone of light fans anteriorly and downward
Posterior to the malleus, part of incus is visible behind the eardrum
,Small blood vessels along the handle of the malleus are normal
Difference in AC vs BC in hearing - ANS In normal hearing, AC>BC
In conductive hearing loss BC>AC
Whispered voice test results - ANS Patient repeats initial sequence correctly = Normal hearing in ear
tested
Patient responds incorrectly or not at all, repeat test for that ear with a new combination of letter and
numbers.
Patient gets at least 3 of 6 letters/numbers correct = Passed hearing screening test
Less than 3 letters/numbers out of 6 are correct = further testing by audiometry.
Weber test results - ANS Normal- sound heard equally in both ears.
Unilateral Conductive hearing loss- sound heard best / lateralizes to impaired ear by bone conduction.
(BC>AC)
Unilateral Sensorineural hearing loss- sound heard best / lateralizes to good ear.
Impaired mobility on pneumatic otoscopy - ANS Decreased mobility of TM with:
Serous effusion
Purulent OM
Thickened TM
No mobility of TM with:
Perforated TM
Conductive hearing loss from problems in outer ear - ANS cerumen impaction
infection (otitis externa)
Trauma
, SCC
Exostosis/osteoma
Conductive hearing loss from problems in middle ear - ANS otitis media
cholesteatomas
otosclerosis
tympanosclerosis
tumors
perforation of TM
Sensorineural hearing loss causes - ANS Presbycusis
Congenital or hereditary conditions
Rubella, CMV
Meniere disease
ototoxic drugs
acoustic neuromas
noise exposure
Lesion of hypoglossal nerve - ANS Suggested by asymmetric protrusion/deviation of tongue to one side.
**Tongue points towards side of lesion.**
Ex. Tongue deviated to right = right CN XII lesion
Vagus nerve paralysis - ANS The soft palate fails to rise on one side and the uvula deviates to opposite
side.
**The uvula points away from the lesion.**
Ex. Uvula deviated to the left = right CN X lesion
Air conduction of hearing - ANS Normal first part of hearing pathway from the external ear through
middle ear
Sound waves travel through air and are transmitted from external and middle ear to the cochlea
Bone conduction of hearing - ANS An alternative pathway that bypasses the external and middle ear and
is used for testing purposes
A vibrating tuning fork, placed on head, sets the bone of the skull into vibration and stimulates the
cochlea directly
Sensorineural hearing phase - ANS Second part of hearing pathway involving the cochlea and cochlear
branch of CN VIII
Tug test - ANS if ear pain or discharge
Move auricle up and down and press on tragus
+ Tug Test in acute otitis
- Tug Test in otitis media
Mastoid process tenderness - ANS -Tenderness present with otitis media and mastoiditis
Normal TM description - ANS Pinkish gray color
Malleus lies behind upper part of the drum
Above the short process of the malleus lies the pars flaccida
Remainder of the TM is the pars tensa
From the umbo, the bright cone of light fans anteriorly and downward
Posterior to the malleus, part of incus is visible behind the eardrum
,Small blood vessels along the handle of the malleus are normal
Difference in AC vs BC in hearing - ANS In normal hearing, AC>BC
In conductive hearing loss BC>AC
Whispered voice test results - ANS Patient repeats initial sequence correctly = Normal hearing in ear
tested
Patient responds incorrectly or not at all, repeat test for that ear with a new combination of letter and
numbers.
Patient gets at least 3 of 6 letters/numbers correct = Passed hearing screening test
Less than 3 letters/numbers out of 6 are correct = further testing by audiometry.
Weber test results - ANS Normal- sound heard equally in both ears.
Unilateral Conductive hearing loss- sound heard best / lateralizes to impaired ear by bone conduction.
(BC>AC)
Unilateral Sensorineural hearing loss- sound heard best / lateralizes to good ear.
Impaired mobility on pneumatic otoscopy - ANS Decreased mobility of TM with:
Serous effusion
Purulent OM
Thickened TM
No mobility of TM with:
Perforated TM
Conductive hearing loss from problems in outer ear - ANS cerumen impaction
infection (otitis externa)
Trauma
, SCC
Exostosis/osteoma
Conductive hearing loss from problems in middle ear - ANS otitis media
cholesteatomas
otosclerosis
tympanosclerosis
tumors
perforation of TM
Sensorineural hearing loss causes - ANS Presbycusis
Congenital or hereditary conditions
Rubella, CMV
Meniere disease
ototoxic drugs
acoustic neuromas
noise exposure
Lesion of hypoglossal nerve - ANS Suggested by asymmetric protrusion/deviation of tongue to one side.
**Tongue points towards side of lesion.**
Ex. Tongue deviated to right = right CN XII lesion
Vagus nerve paralysis - ANS The soft palate fails to rise on one side and the uvula deviates to opposite
side.
**The uvula points away from the lesion.**
Ex. Uvula deviated to the left = right CN X lesion
