Examinations of the ears

Our ears play an important role in our everyday lives. They help us to orientate ourselves in space, transmit information and enable communication with others. The balance organ is also located there. What examinations and tests can the ear, nose and throat doctor (ENT doctor) carry out if something is wrong with the ear? You can find out here.

Discussion with the patient before the ear examination

The main complaints that bring patients to an ear specialist are hearing loss, pain, drooling, ringing in the ears   and  dizziness . First, the doctor will ask if the symptoms came on suddenly or gradually, affecting one or both ears. It is also interesting for him whether there are other complaints or illnesses, whether certain  medications  are being taken and whether the person concerned has been exposed to a lot of noise in the past.

Similar complaints in the family can also provide important information about the cause of the disease. A suspected diagnosis is often already made; further examinations then serve to refine the diagnosis and to create or control the treatment concept.

The basic diagnostics: basic examinations

The physical examination is mainly performed with the patient sitting or standing. Externally visible signs of illness  (inspection)  are, for example, swelling behind the ear and nodules, scarring or crusting in the auricle.

Examination of the external auditory canal and the eardrum with a funnel-shaped ear microscope  (otoscopy) plays an important role. Earwax and other  secretions   , the condition of the skin and constrictions are checked and the eardrum is assessed. Its color, shape, surface texture and integrity provide important clues to certain diseases such as  middle ear infections  or ventilation disorders.

The connection of the ears with the nasopharynx is   assessed in a nasal reflection.

Functional tests of the ears

Various tests can be used to check how far one can hear, which tones are perceived how well and how sound conduction works in the ear. Important functional tests for examining the ears are:

• tuning fork tests
• Audiometrie

tuning fork tests

Hearing can be checked roughly with a tuning fork, but only if the patient cooperates. For this reason, these examinations are only suitable to a limited extent for small children, for example.

The tuning fork is made to vibrate on a solid object and then – depending on the test – held alternately in front of the external auditory canal and on the bone behind the ear  (Rinne test)  or placed in the middle of the skull  (Weber test).  The patient then has to say when and where he hears the sound better. The examiner can thus distinguish whether a pathological process is present and where in the ear it is likely to be located.

Audiometrie

These hearing tests are more accurate than the tuning fork test and some can even be performed independently of the patient’s cooperation (objective audiometry).

• Tone audiometry:  Tones of different pitch and volume are transmitted to the examinee via headphones or a sound generator placed behind the ears. As soon as he hears something, he has to indicate this, for example by pressing a button. In children, the reaction to sounds can be measured, for example, by the reflexes or movements triggered by them.
• Speech audiometry:  Instead of tones, polysyllabic numbers and monosyllabic words are played. In this way, language comprehension can be checked.
• Objective audiometry:  This method is one of the electrophysiological examinations in which electrical activities are registered via small electrodes. In  electrical  response audiometry, the responses elicited by sounds are measured directly at various locations in the brain, such as the cerebral cortex (electric response audiometry =  ERA ) or the brainstem (brainstem evoked response audiometry =  BERA ). This can be done using an electroencephalogram. In addition, the sound waves produced by the hair cells in the inner ear can be determined using highly sensitive microphones in the outer auditory canal (otoacoustic emissions =  OAE ).

To assess the middle ear, the resistance that the eardrum and ossicular chain oppose to external sound  (impedance measurement),  the ability of the eardrum to transmit sound  (tympanometry),  and the protective mechanism of the stapes muscle to contract when exposed to noise  (stapedius reflex) can also be measured.  Changes in these measurements can be caused, for example, by calcification or negative pressure in the middle ear.

Functional tests of the vestibular system

A whole series of examinations serves to get to the bottom of vertigo attacks. They take advantage of the fact that the balance organ in the inner ear is directly or indirectly linked to other structures such as the brain, the eyes or the pressure receptors on the skin for spatial orientation and coordination.

• The coordination tests include the  Romberg test,  in which the patient has to stand with his eyes closed and arms outstretched, and the  Unterberger test,  in which he also walks on the spot. However, whether the balance problems originate from the vestibular organ in the inner ear or from a central point in the brain requires further investigation.
• In  nystagmus tests  , special  glasses  are used while sitting to examine when and how a rhythmic eye movement occurs, even in healthy people (e.g. when looking out of a moving vehicle). In addition, such eye trembling can also be triggered in the lying patient by cold or warm water rinsed into the ear (caloric nystagmus). If the side and shape of the nystagmus deviate from the usual, this gives clues to the cause of a balance disorder.

Further examinations of the ears

Imaging methods are mainly used when changes to the bones or brain tissue are suspected:

• Since the bones in the ear area are superimposed, there are some special techniques, especially for  X-ray images  of the petrous bone (photograph according to Schüller or Stenvers).
• Computed  tomography  (CT) is indicated when  bone fractures  (e.g. after an accident), malformations or a tumor are suspected.
• Magnetic resonance imaging is also used for the latter   . If contrast medium is also injected, vessels can also be visualized.