![]() ![]() The doctor proceeds to perform a focused ENT exam. Her right ear appears to be the troubling ear and she is experiencing mild pain on that side. Sarah presents to the Emergency Department and mum narrates the story to the attending doctor. Ask the child whether the sound was louder at the beginning (when it was held against their mastoid) or whether it became louder (when it was held in front of their ear).Leave it there for a few seconds before taking the tuning fork away from their ear.Allow it to stay there for 2-3 seconds to allow them to appreciate the intensity of the sound then promptly raise the fork off the mastoid process and place the vibrating tips about 1cm from their external auditory meatus.Place the base against the patient’s mastoid process (for those who like to watch it on a video, check one out here).Begin by striking a 512 Hz tuning fork against your knee or elbow.In a normal situation, air conduction is greater than bone conduction. Rinne’s test aims to compare air conduction with bone conduction. Ask about pain especially over the mastoid. ![]() ![]() Try to put them at ease and make sure they are sitting comfortably, ideally in a silent room. There is no known family history of deafness and Sarah does not swim.īefore you begin the exam, it is important to explain to the child what you are about to do to in way they can understand. Sarah is generally well and has no other past medical or drug history. The GP is concerned and feels that he has exhausted every treatment option and decides to refer for review in the Emergency Department. Otoscopy shows a very narrow external auditory canal, dermatitis and a milky discolouration of the external ear. Michelle is worried and brings Sarah to the GP the following day. Sarah has undergone numerous treatments for ear infections in the past with oral antibiotics and topical treatments as well. The situation prompts mum to act following her attendance of the Parent-Teacher’s meeting where complaints are made about Sarah’s inattentiveness in class, consequently leading to her grades dropping. Mum has noticed that the volume of the TV is higher and many times she has ignored the doorbell ringing (according to mum it’s impossible to miss the doorbell!). This is concerning and out of the norm for Sarah who is usually very witty and quick to respond. Over the summer, her mum, Michelle, notices that Sarah has become more ‘absent’ and doesn’t seem to be hearing anything she tells her. She is very excited to be back at school after many months of limited contact with friends amid the pandemic. Sarah is a 9-year-old girl who has just begun Grade 4. This article provides a clinical approach to assessing a child with hearing difficulty using Weber’s and Rinne’s tests and a guide to interpreting the examination findings. The most common cause of conductive hearing loss in children is otitis media with effusion, otherwise known as glue ear. Conductive hearing loss typically occurs due to a disruption in the transmission of sound at the level of the external or middle ear. It results from a disturbance of the auditory pathway involving the cochlea of the inner ear, through to the brainstem. The former, sensorineural, although generally uncommon in children, is the main cause of permanent hearing loss in the paediatric setting. There are three main types of hearing loss: sensorineural, conductive and mixed. Clinicians need to be able to to identify potential reversible causes and rule out more sinister conditions. Early detection and management are essential for proper language and psychosocial development of children. Hearing loss in children may be due to a broad range of pathology. ![]()
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