It is the first contact between patient and the ENT specialist. After an accurate collection of the patient’s clinical history the specialist carries out a visual examination of the oral and nasal cavities and the ear followed , when required, by an indirect laryngoscopy examination of the hypopharynx , the larynx and the vocal cords. This will make it possible to make a diagnosis or prescribe further specialized examinations.
Pure Tone Audiometry Examination
The pure tone audiometry examination is the subjective measurement of a patient’s hearing ability . It is a non-invasive examination and is conducted with the patient seated in a sound proof room. The patient is tested with headphone placement and is instructed to respond to the softest tone they can hear at various frequencies. The frequency range tested is typically 250-8000 Hz with the intensity range from -10dBHL to 120dBHL. The next examination is testing the patient’s hearing by bone conduction. A small bone conduction vibrator is placed behind the patient’s ear (on the mastoid process of the temporal bone) and the test protocol is the same as for pure tone audiometry. By evaluating the responses from both air and bone conduction testing, the otolaryngologist will be able to determine hearing status and in the event of a hearing loss, the type of hearing loss e.g. conductive (middle ear related) or sensorineural (inner ear related). Tympanometry serves to define the status of the middle ear (e.g. negative pressure, poor mobility of the tympanic membrane, etc.).
Speech Audiometry Exam
Speech audiometry is the measurement of the patient’s ability to discriminate (i.e. understand) words. It is carried out with the same equipment used for the pure tone audiometry but in this case the sound stimulus is no longer a pure tone but are two syllable words . These words are spoken to the patient in groups of ten and with increasing intensity. For each group the examiner writes down on a graph the percentage he patient can repeat correctly. From the final examination of the graph the specialist derives the patient’s degree of comprehension of speech.
Tympanometry examen
Tympanometry is an objective test of middle ear function. The examination measures energy transmission through the middle ear. It is a non-invasive examination that takes minutes to administer. It is carried out with a small probe that is inserted into the patient’s ear. Through this small probe a tone is presented in the ear canal while air pressure is varied through the probe. Based on the energy absorbed or reflected from the middle ear with the variations in air pressure the status of the patient’s tympanic membrane, middle ear pressure , and ossicles (small bones in the middle ear) can be determined.
Vestibular examination
The vestibular examination allows the ENT specialist to examine the patient’s sense of balance. It is a non-invasive test which is carried out with specialized instrumentation. The simplest examination consists of having the patient evaluated in different postures ,e.g. standing at attention, with arms stretched forward, etc. and having the patient walk with eyes closed to check if there is deviation from the forward direction. The patient’s head can be moved in specific ways while sitting or lying on the examination table.These tests, for example, help to diagnose benign paroxysmal vertigo. Additional testing allows for the stimulation of the two receptors of balance with water at 44 °C or 30 °C injected first into one ear and then into the other. This last examination (caloric test) triggers the onset of a particular motor reflex of the patient’s eye named Nystagmus which is recorded with an infrared camera. Nystagmus is a rapid movement of the eye to one side of the head, followed by a slow return back to the rest position. From the examination of nystagmus the ENT specialist can identify any deficiency in the functioning of the balance receptors of one ear compared to the other.
Directed Rhinopharynx and larynxscopy with optical fibers
The Directed Rhinopharynx and larynxscopy examination is carried out with the help of rigid or flexible optical fibers connected to a camera and video recording system By of such fibroscopes into the patient’s nasal or oral cavities (maneuver generally well tolerated even by small patients) the ENT specialist examines the nasal cavities as well as the rhinopharynx, oropharynx, hypopharynx and larynx of the patient and evaluates the presence of any acute or chronic pathology and the motility of the vocal cords.
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