TUNING FORK TESTS

Tuning fork tests are an integral part of ear examination which help us assess the FUNCTION of the ear....HEARING.
There are many Tuning fork tests but the commonly performed are 3
1) Rinne's Test
2) Weber's Test
3) Absolute Bone Conduction Test
The tests essentially tell us whether the hearing loss is....
a) CONDUCTIVE...the pathology is in the EXTERNAL EAR +/- MIDDLE EAR.....Treatment is Medical +/- Surgical.
b) SENSORI NEURAL...the pathology is in the INNER EAR or beyond....Providing a commensurate hearing aid is the only treatment.
c) MIXED
So the competence to perform these tests properly is mandatory .
The tests need to be discussed under the following headings
Principle
Procedure
Observstion/s
Inference
Exception/s 

RINNE'S TEST

                                             
WEBER'S TEST

                                            

ABSOLUTE BONE CONDUCTION TEST

Dear All,
Posting a few images of ears for clinical discussion.

Image No. 1) 

Image No. 2)

Points to notice -
1) Both the images are of the RIGHT ear as is our protocol ( for matters of convenience).
2) Image No. 1 shows a big DEFECT in the Tympanic Membrane.
3) Image No. 2 shows multiple discrete chalky flakes on the Tympanic Membrane....these are typical TYMPANOSCLEROTIC patches which suggest old affection of the Middle Ear (probably an old c/o Otitis Media)...this is an extension of our discussion yesterday in the theory class on Otosclerosis.....this condition can mimic Otosclerosis (Differential diagnosis) in the sense that here too patient may complain of hard of hearing WITHOUT any h/o earache, otorrhoea ....the ONLY thing that will distinguish it from Otosclerosis is the ABNORMAL appearance of TM.

Points to ponder -
1) Which type of perforation does the Image No. 1 denote?
2) What is the type of CSOM here?
3) What are the Synonyms for this type of CSOM?
4) Waht is the Management of this condition?

Dear Friends,
Posting some images

Trick photography apart, my intention is to draw your attention to the utmost importance one needs to attribute to the perception of the third dimension....THE DEPTH OF FIELD ....to get an idea of the relative distance of objects from one another...In ENT (as anywhere in life) and more so in an accurate ear examination and to come to correct diagnosis,Sterioscopic or Binocular vision is A MUST. To ensure this, the classical or conventional ENT Setup of Bull's Eye Lamp and Head Mirror is extremely useful... 

Dear Friends,
Trying something different to ensure that the vdos are compatible to run on mobile devices. Please bear with us.
A small vdo of ear cleaning in the OPD.
https://youtu.be/x4h4Vcs8PsI
Please peruse and give your feedback.
Amol.

Dear Friends,
Adding one image and a commensurate vdo.
Please peruse.

Ear Examination with
Speculum

Also note 3 subtle points -
1) An attempt ALWAYS to keep the hand/s out of path of the light to ensure that no shadows are thrown inadvertently compromising the illumination of the area of interest.
2) Using the largest possible ear speculum with the objective of trying to examine the Tympanic Membrane in its entirety.
3) Introduction of the ear speculum is done in a gentle screwing action to prevent undue stimulation and avoid a possible vasovagal syncope.

Dear All
Uploading a small vdo clip of Ear Examination which adheres to the basic prerequisite of -
Consistent and Concentrated source of illumination in the form of the conventional setup of Bull's Eyelamp and Head Mirror.
The vdo also extolls on the virtue of -
1) First honest attempt for a naked eye examination (i.e. without Magnification)
2) Without instrumentation.