The medical assistant's role in ear examinations and treatments

Assisting with examination and diagnostic procedures of the ear

As with examination and diagnostic procedures of the eye, the medical assistant can be involved in the examination and diagnostic procedures of the ear. These examinations and diagnostic procedures will likely be screening in nature with a referral to an otolaryngologist if needed.

The following sections discuss how the medical assistant is involved in the examination and diagnostic procedures of the eye.

Assisting with the examination of the ear

An ear examination involves viewing the external auditory canal with an otoscope covered by an ear speculum. Disposable plastic speculum covers should be used each time to prevent disease transmission. A normal otoscopic examination reveals an external auditory canal with a small amount of cerumen and a pearly gray and concave tympanic membrane. In addition to performing the otoscopic examination, the provider palpates the area around the pinna for abnormalities or sensations. A number of tests are used to assess hearing acuity, ranging from simple tuning fork tests to quantitative and qualitative audiometric testing. If a hearing loss is suspected, the next test usually is performed with a tuning fork.

Useful questions for gathering a history of ear problems

• Are you experiencing nausea, vomiting, dizziness, ear pain, fever, headache, upper respiratory infection, ringing of the ears, drainage, loss of balance, or hearing loss?
• What are the onset, duration, and frequency of symptoms?
• Have you taken any medication for the symptoms? If so, what medication? Has it helped?
• Do you have a problem with both ears?
• Are you experiencing pain? On a scale of 1 to 10, with 10 being the worst pain, how would you rate the pain? Is it localized or radiating, in one ear or both?
• Has anything you have tried relieved the symptoms?

Tuning fork testing

Tuning fork tests measure hearing by air conduction and bone conduction. Remember that in bone conduction, the sound vibrates through the cranial bones to the inner ear. Tuning forks are available in different sizes, each with a different frequency. The most commonly used tuning fork is the 512 hertz (Hz), which means that it vibrates 512 cycles per second, the level of normal speech patterns. To activate the fork, the provider holds it by the stem and strikes the tines softly on the palm of the hand. Striking the tines too forcefully creates a tone that is too loud for diagnostic use. The two tests used to evaluate hearing are the Weber and Rinne tests. Both of these procedures are commonly used to evaluate conductive and sensory losses.

The Weber test is used if the patient reports that hearing is better in one ear than in the other. The vibrating fork is placed in the center of the top of the head, and the patient is asked in which ear the tone is louder or if the tone is the same in both ears. Because the patient hears the tone by bone conduction through the head, a normal result is hearing the sound equally in both ears.

The Rinne test is designed to compare air conduction sound with bone conduction sound. In this test, the stem of the vibrating fork is placed on the patient’s mastoid process, and the patient is instructed to raise a hand when the sound disappears. The fork is quickly inverted so that the vibrating tines are approximately 1 inch in front of the external ear canal. If hearing is normal, the patient should still hear a sound. In normal hearing, the sound is heard twice as long by air conduction as by bone conduction.

Audiometric testing

An audiometric test may be done in an otology or a family practice and is performed by medical assistants who have received additional training. Audiometry measures the lowest intensity of sound an individual can hear. The patient, frequently a child, is assisted in placing headphones over the ears.

Newer machines give the operator the choice of performing a traditional manual hearing test or an automated one. In the automatic mode, the patient is prompted through the earphones to press a hand button upon hearing a tone. The advantages of automated machines are that voice prompts are available in multiple languages, and the test requires less time to complete. The medical assistant can watch the progress of the test on the audiometer’s LCD screen. Whether the test is delivered manually or with an automated model, each ear is tested by delivering a single frequency at a specific intensity, starting with low-frequency tones and going up to very high frequencies. The patient is asked to signal when the sound is heard. The results are printed on a graph, called an audiogram, or the medical assistant charts the results on a graph sheet. Adults with normal hearing can hear tone frequencies below 25 decibels, and children with normal hearing can hear those below 15.

If initial screening indicates a hearing deficit, the provider may recommend an appointment with an audiologist for an audiometric evaluation. The evaluation consists of a battery of tests that assesses the level of hearing impairment and provides valuable information as to how the patient may be helped. The first test evaluates speech comprehension and assesses the patient’s ability to follow verbal instructions. Once this evaluation is complete, the patient is placed in a soundproof booth with earphones over the ears. From this point on, the audiologist speaks to the patient and conducts all testing through the earphones. The assessment includes testing the frequency, intensity, and audibility of sound. This process takes approximately 1 hour.

Assisting with treatments of the ear

A medical assistant may be involved in providing treatments for diseases or disorders of the ear. The following sections discuss two of the most common treatments for the ear.

Ear Irrigation

Irrigation of the ear is done to remove excessive or impacted cerumen, remove a foreign body, or treat the inflamed ear with an antiseptic solution. A medical assistant with the proper training and competency may perform the ear irrigation procedure when ordered by the provider. To prevent discomfort for the patient, it is important to administer the irrigating solution with the applicator tilted up toward the top of the external canal, so that the solution is not directed at the tympanic membrane. Some discomforts the patient may experience during ear irrigation include vertigo, coughing, or a tickle in the back of the throat. Perform the procedure as prescribed, making sure the patient is comfortable. Always document the treatment and its results immediately after completion.