You are seeing Mr. Syed, a 73 year old man, in your outpatient clinic. He says that his family members have told him that they have a difficult time communicating with him because he has poor hearing. Take a focused history, and perform the pertinent physical examination maneuvers.
History
- Inquires whether patient is aware of hearing loss (he agrees)
- Onset of hearing difficulty
- Settings in which difficulty is worst (noisy crowds)
- Whether hearing difficulty is worse with specific frequency (patient unsure)
- Otalgia
- Exudation from ear, including pus and blood (none)
- Phonophobia
- Tinnitus
- Vertigo
- Associated neurologic deficits elsewhere in the body
- Vision loss
- Headache
- Use of ear plugs
- Trauma to the ear, including digital
- Past history of cerumen
- Use of any hearing aids
- Past history of hearing difficulty
- Past exposure to noise (including occupational history)
Physical Examination
Inspection
- Comments on the gross appearance of both ears
- Uses otoscope to examine the auditory canal, commenting on its appearance
- Examines tympanic membrane and comments on its appearance
Special Tests
- Performs the Rinne Test bilaterally
- Performs the Weber Test
- Interprets the results of these two tests
- Performs whisper test bilaterally
Case 3 – Hearing Difficulty