Ear, Otoscopy and Hearing OSCE Examination Quiz

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After finishing otoscopy and a bedside hearing check, what is the most appropriate way to round off the examination?

Thank the patient, wash your hands, summarise the hearing findings, and arrange formal hearing tests only if the eardrum looks abnormal. Thank the patient, wash your hands, summarise the hearing findings, and refer the patient for cochlear implantation if any sensorineural loss is found. Thank the patient, wash your hands, summarise the hearing findings, and suggest relevant further examination and formal hearing tests. Thank the patient, wash your hands, summarise the otoscopy findings, and arrange a CT of the temporal bones for any conductive hearing loss. Thank the patient, wash your hands, summarise the hearing findings, and prescribe topical antibiotic drops if the patient has any ear discharge.

A Thank the patient, wash your hands, summarise the hearing findings, and arrange formal hearing tests only if the eardrum looks abnormal.
B Thank the patient, wash your hands, summarise the hearing findings, and refer the patient for cochlear implantation if any sensorineural loss is found.
C Thank the patient, wash your hands, summarise the hearing findings, and suggest relevant further examination and formal hearing tests. ✓
D Thank the patient, wash your hands, summarise the otoscopy findings, and arrange a CT of the temporal bones for any conductive hearing loss.
E Thank the patient, wash your hands, summarise the hearing findings, and prescribe topical antibiotic drops if the patient has any ear discharge.

The answer is C: Thank the patient, wash your hands, summarise the hearing findings, and suggest relevant further examination and formal hearing tests.

Explanation

Why C is correct

See Gross Hearing Assessment. Option C is correct. Finishing an ear examination is a skill in itself. You thank the patient, clean your hands, and then summarise what you found: the appearance of the ear canal and eardrum (tympanic membrane), and the hearing. If hearing seemed reduced, say which ear is affected and whether the tuning fork tests suggest a conductive loss (a problem carrying sound through the outer or middle ear) or a sensorineural loss (a problem in the inner ear or hearing nerve). Then you propose targeted next steps. These include examining the cranial nerves, especially the facial nerve (cranial nerve VII), because it runs through the temporal bone close to the middle ear and can be affected by middle-ear disease. You would also assess balance if the patient has dizziness, examine the nose and throat, and arrange formal hearing tests. Tympanometry (a test of how well the eardrum moves, which reflects middle-ear function) and pure tone audiometry (listening to tones of different pitches through headphones) are examples of those tests. A helpful memory aid for any examination: thank, clean, summarise, suggest.

Summary: describe the ear canal, eardrum and hearing, including conductive or sensorineural loss.
Next steps: examine the cranial nerves, especially the facial nerve, assess balance if dizzy, and examine the nose and throat.
Tests: arrange formal hearing tests such as tympanometry and pure tone audiometry.

Why the other options are incorrect

A. Thank the patient, wash your hands, summarise the hearing findings, and arrange formal hearing tests only if the eardrum looks abnormal.: Sensorineural hearing loss commonly occurs with a normal eardrum because the problem lies in the cochlea or auditory nerve. Making formal hearing tests conditional on an abnormal eardrum would miss many important causes of reduced hearing.
B. Thank the patient, wash your hands, summarise the hearing findings, and refer the patient for cochlear implantation if any sensorineural loss is found.: Cochlear implantation is reserved for severe to profound sensorineural loss that has not responded to hearing aids, not for any sensorineural loss. Referring every patient with a sensorineural finding would be disproportionate and not part of routine rounding off.
D. Thank the patient, wash your hands, summarise the otoscopy findings, and arrange a CT of the temporal bones for any conductive hearing loss.: Conductive hearing loss is assessed by formal audiometry and examination, not by routine CT of the temporal bones; imaging is reserved for suspected cholesteatoma, trauma or complications.
E. Thank the patient, wash your hands, summarise the hearing findings, and prescribe topical antibiotic drops if the patient has any ear discharge.: Not all ear discharge needs topical antibiotic drops; treatment depends on whether the discharge comes from otitis externa, a perforated eardrum or another cause. Prescribing drops without a diagnosis is not the same as finishing the examination with a targeted plan, and some discharges need specialist assessment.

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More questions from this set. Start the quiz to answer them and see each explanation.

1
After explaining otoscopy, obtaining consent and checking for pain, you are about to examine an adult's right ear. Which combination is most appropriate?
2
A 7-year-old child has reduced hearing several weeks after a cold but no current fever or acute ear pain. Otoscopy shows a dull, mildly retracted tympanic membrane with an air-fluid level and bubbles behind it. The ear canal is clear and the membrane is intact. What is the most likely diagnosis?

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