Hearing impairment physical examination

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Physical Examination

Ear

• Weber's tuning fork testing
• Rinne's tuning fork testing
• Finger rub
• Whisper test
• Handheld audiometer
• Mobile apps and smartphones audiometer

Finger rub	Whisper test	Handheld audiometer	Mobile apps and smartphones audiometer	Weber's tuning fork testing	Rinne's tuning fork testing
Examiner gently rubs fingers together close to the patient's ear.	Examiner stands at arm's length (approximately 2 feet) behind the patient. The patient blocks 1 ear himslef. Examiner whispers 5-6 letters/number combinations.	Examiner holds device in patient's ear one at a time. Patient indicates awareness of each tone.	Advancement of science has let to the development of mobile technology–based screening options, such as use of different mobile apps (for example, uHear, Mimi) and smartphone or tablet based portable audiometers that can be adjusted to perform screening for hearing impairment.	Strike a tuning fork and place it on the middle of the forehead. A normal test produces sound on both sides (no lateralization).	Strike a tuning fork and place it on the mastoid bone behind the ear. When the patient indicates no further sound, move the still-vibrating fork to the ear. In a normal test, the patient will still hear air-conducted sound (air conduction should be better than bone conduction). AC > BC
A positive result is a failure to identify rub in ≥2 of 6 attempts.	The positive result is failure to repeat ≥3 of the 6 combinations	Positive result is failure to identify either the 1000- or 2000-Hz frequency in both ears or the 1000- and 2000-Hz frequencies in 1 ear.	They generally require supra-aural headphones for monitoring.	In unilateral conductive loss, the sound will be louder in the affected ear. In sensorineural hearing loss, the sound will lateralize to the better-hearing ear.	With conductive loss, the patient will not hear the air conducted sound. This AC< BC.

• Abnormalities of the tympanic membrane on inspection, such as scarring suggest a history of middle ear disease, and a visible perforation or cerumen impaction may suggest conductive hearing loss.