Download Hearing Loss Evaluation: Weber and Rinne Tests, Causes, and Symptoms and more Study notes Pharmacology in PDF only on Docsity!
Ears No worries—let’s break it down even further so it’s simple and clear. Think of the tests as two friends (Weber and Rinne) who work together to figure out if the problem is outside the ear (conductive) or inside the nerve (sensorineural). I'll walk you through each test step by step, and then explain how they help you decide what's going on. Step-by-Step for the Tests
1. Weber Test: "Which ear is louder?" What it does: It compares the two ears to find out if one is hearing better or worse. How you do it: 1. Tap the tuning fork to make it vibrate. 2. Place the base of the fork in the middle of the forehead (or the top of the head). 3. Ask, “Where do you hear the sound? In both ears equally, **or louder in one ear?”
- Rinne Test: "Air or bone: Which is better?"** What it does: It checks if sound is better through the air (normal) or bone (abnormal if bone is louder). How you do it: 1. Tap the tuning fork to make it vibrate. 2. Place the fork’s base on the mastoid bone (just behind the ear). 3. Ask, “Can you hear this? Tell me when it stops.” 4. When the patient says the sound is gone, move the fork close to their ear (but not touching). 5. Ask, “Can you hear it now?” How the Results Work Think of the results as a clue about what’s happening in the ear.
Weber Test Results Normal: Sound is equal in both ears. Louder in the bad ear: Conductive hearing loss (something is blocking sound, like wax or fluid, so the bad ear picks up more vibration). Louder in the good ear: Sensorineural hearing loss (the nerve in the bad ear isn’t working well, so it can’t hear as much). Rinne Test Results Normal: Air conduction (AC) is louder than bone conduction (BC). Conductive hearing loss: Bone conduction is louder than air conduction (BC > AC). Sensorineural hearing loss: Air conduction is louder than bone conduction (AC > BC), but both are reduced because the nerve is damaged. How They Work Together You use the Weber test to figure out which ear might have a problem and what kind of problem it is: If the Weber test is louder in one ear, you know that ear is the "bad ear." Then, you use the Rinne test to confirm the type of hearing loss: If bone conduction is louder (BC > AC), it’s conductive hearing loss. If air conduction is louder but reduced (AC > BC), it’s sensorineural hearing loss. Simplified Flow Chart
- Start with Weber Test : o Equal sound: No issue, or normal hearing. o Louder in one ear: Move to the Rinne test.
- Use Rinne Test on the affected ear:
Acoustic neuromas (tumors on the hearing nerve) When acquiring a patient’s ear-related history, potential initial open-ended questions include, “How is your hearing?” and “Have you had any trouble with your ears?” In a comprehensive ear history, you should inquire about hearing loss, ringing in the ears (tinnitus), ear drainage (otorrhea), ear pain (otalgia), and vertigo. For the nose-related history, opening questions include, “Do you have any complaints related to your nose?” Ask questions pertaining to any nosebleed (epistaxis), nasal discharge (rhinorrhea), nasal obstruction, and postnasal drip If the patient has noticed hearing loss, does it involve one or both ears? Did it start suddenly or gradually? What are the associated symptoms, if any? It is critical to establish a timeline related to any reported hearing loss. Sudden onset hearing loss, particularly sensorineural hearing loss, without a known cause should be immediately referred to an otolaryngologist. These patients may benefit from urgent medical intervention. Hearing loss may also be congenital, from single gene mutations.2,3 Distinguish conductive loss, which results from problems in the external or middle ear, from sensorineural loss, resulting from problems in the inner ear, the cochlear nerve, or its central connections in the brain. People with sensorineural loss have trouble understanding speech, often complaining that others mumble; noisy environments make hearing worse. In conductive loss, noisy environments may help Medications known to cause permanent hearing loss include aminoglycosides (e.g., gentamicin) and many chemotherapeutic agents (e.g., cisplatin and carboplatin). Temporary damage to hearing may be caused by aspirin, nonsteroidal anti-inflammatory agents (NSAIDs), quinine, and loop diuretics (e.g., furosemide). Ear Pain (Otalgia) Common causes of ear pain: o Ear infection (Otitis): Otitis externa (external ear canal infection): Pain in the outer ear. Otitis media (middle ear infection): Pain deeper in the ear. o Referred pain : Ear pain may come from other areas like the mouth, throat, or neck.
Symptoms to ask about: o Associated with fever, sore throat, cough, or upper respiratory infection : These make ear infections more likely. o Ear discharge : Yellow-green discharge is common with otitis externa, otitis media, or a perforated eardrum. o Trauma : Injury to the ear can also cause pain and discharge. o Earwax or debris : This is usually normal and not a sign of infection. Keep these key points in mind to understand where the pain is coming from and what might be causing it. Tinnitus is a common symptom, increasing in frequency with age. When associated with fluctuating hearing loss and vertigo, suspect Ménière disease Dizziness Evaluation Ask the patient to describe their feeling without using the word "dizzy." o Vertigo : Feeling like the room is spinning or tilting (likely from inner ear or CN VIII issues). o Presyncope : A feeling of fainting or passing out (often from heart or blood flow issues). o Dysequilibrium : A sense of unsteadiness or losing balance (can be from various causes). Ask : "Do your symptoms get worse when you move your head?" (Helps identify if symptoms are positional). Vertigo (spinning sensation) is often linked to: o Inner ear problems (labyrinth), o Peripheral CN VIII issues , or o Brainstem or central pathway lesions. Distinguish : Peripheral vertigo (from inner ear) vs central vertigo (from brain). Understanding Vertigo and Dizziness Evaluation
o Arrhythmia : Abnormal heart rhythms. o Orthostatic hypotension : A sudden drop in blood pressure when standing up. o Vasovagal stimulation : A drop in heart rate and blood pressure, often triggered by stress, pain, or standing too long. This approach helps figure out if dizziness is due to an ear problem (vestibular disease), brain issue (central nervous system), or heart/blood pressure problems (presyncope). Understanding Rhinorrhea (Nasal Drainage) and Congestion
- Rhinorrhea : This is the term for drainage or mucus coming from the nose, often leading to a feeling of nasal congestion or stuffiness. o Associated Symptoms : Sneezing Watery eyes Throat discomfort Itching in the eyes, nose, and throat
- Possible Causes : o Viral Infections : Like a cold or flu. o Allergic Rhinitis ("hay fever"): An allergic reaction to things like pollen, dust, or animal dander. o Vasomotor Rhinitis : Non-allergic inflammation of the nasal passages, often triggered by things like weather changes, smoke, or strong odors. Key Questions to Ask the Patient: Timing of Symptoms : o Do the symptoms happen during the cold season and last less than 7 days? (More likely a viral infection) o Do the symptoms happen at the same time each year, like during pollen season? (This points to allergic rhinitis)
o Are the symptoms triggered by animals, specific environments, or dust? (Can indicate environmental allergies) What Remedies Have Been Tried? o Has the patient used any over-the-counter medications, and how effective were they? Drug-Induced Rhinitis : o Excessive use of nasal decongestants or drugs like cocaine can cause rhinitis (inflammation of the nose). Signs of Sinus or Nasal Infections: Acute Bacterial Sinusitis (Rhinosinusitis) : o If the symptoms last longer than 7 days and involve purulent (yellow-green) nasal discharge and facial pain , it may be bacterial sinusitis. o Associated symptoms: loss of smell, tooth pain, facial pain (worsened by bending forward), ear pressure, cough, or fever. Special Considerations: Medication-Induced Rhinitis : o Drugs like oral contraceptives, alcohol, or cocaine may cause nasal stuffiness. One-Sided Nasal Congestion : o If the congestion is only on one side, consider the following causes: Deviated nasal septum : A misalignment of the septum inside the nose. Nasal polyp : Non-cancerous growths in the nasal passages. Foreign body : Something stuck in the nose. Granulomatous disease : A type of inflammation.
Recurrent Bleeding : Is this bleeding a frequent problem for the patient? Other Signs of Bleeding : Does the patient have easy bruising or unexplained bleeding elsewhere in the body? Medications and Conditions That Can Contribute to Epistaxis: Anticoagulants : Blood thinners, like warfarin or aspirin, can increase bleeding. NSAIDs : Non-steroidal anti-inflammatory drugs (e.g., ibuprofen) can also cause bleeding. Vascular Malformations : Abnormal blood vessels in the nose that may rupture and cause bleeding. Coagulopathies : Blood clotting disorders that make it harder to stop bleeding. This helps in identifying whether the bleeding is related to something simple (like nose picking) or a more complex medical condition (like blood thinners or a clotting disorder).
