Earache Earache Earache may occur in isolation or along with discharge or, rarely, hearing loss. Ear pain may come from a process within the ear itself or may be referred to the ear from a nearby nonotologic... read more , hearing loss Hearing Loss Worldwide, about half a billion people (almost 8% of the world's population) have hearing loss ( 1). More than 10% of people in the US have some degree of hearing loss that compromises their... read more 
, otorrhea Otorrhea Ear discharge (otorrhea) is drainage exiting the ear. It may be serous, serosanguineous, or purulent. Associated symptoms may include ear pain, fever, pruritus, vertigo, tinnitus, and hearing... read more , tinnitus Tinnitus Tinnitus is a noise in the ears. It is experienced by 10 to 15% of the population. Subjective tinnitus is perception of sound in the absence of an acoustic stimulus and is heard only by the... read more , and vertigo Dizziness and Vertigo Dizziness is an imprecise term patients often use to describe various related sensations, including Faintness (a feeling of impending syncope) Light-headedness Feeling of imbalance or unsteadiness... read more are the principal symptoms of ear problems.
In addition to the ears, nose, nasopharynx, and paranasal sinuses, the teeth, tongue, tonsils, hypopharynx, larynx, salivary glands, and temporomandibular joint are examined; pain and discomfort may be referred from them to the ears. It is important to examine cranial nerve function How to Assess the Cranial Nerves (See also Neuro-ophthalmologic and Cranial Nerve Disorders and Introduction to the Neurologic Examination.) Smell, a function of the 1st (olfactory) cranial nerve, is usually evaluated only... read more (see table ) and to perform tests of hearing Physical examination Worldwide, about half a billion people (almost 8% of the world's population) have hearing loss ( 1). More than 10% of people in the US have some degree of hearing loss that compromises their... read more and of the vestibular apparatus. The patient is also examined for nystagmus Nystagmus Nystagmus is a rhythmic movement of the eyes that can have various causes. Vestibular disorders can result in nystagmus because the vestibular system and the oculomotor nuclei are interconnected... read more (a rhythmic movement of the eyes).
Testing
Patients with abnormal hearing on history or physical examination or with tinnitus or vertigo undergo an audiogram Testing Worldwide, about half a billion people (almost 8% of the world's population) have hearing loss ( 1). More than 10% of people in the US have some degree of hearing loss that compromises their... read more .
Patients with nystagmus Nystagmus Nystagmus is a rhythmic movement of the eyes that can have various causes. Vestibular disorders can result in nystagmus because the vestibular system and the oculomotor nuclei are interconnected... read more or altered vestibular function may benefit from computerized videonystagmography (VNG) or electronystagmography (ENG), which quantifies spontaneous, gaze, or positional nystagmus that might not be visually detectable. In ENG, eye movements are recorded by electrodes placed around the eye, while in VNG they are recorded by infrared goggles. In both cases, data are analyzed by computer and interpreted by an audiologist. Computerized VNG or ENG caloric testing quantifies the strength of response of the vestibular system to cool and warm irrigations in each ear, enabling the physician to discriminate unilateral weakness. Different components of the vestibular system can be tested by varying head and body position or by presenting visual stimuli.
Posturography uses computerized test equipment to quantitatively assess the patient's control of posture and balance. The patient stands on a platform containing force and motion transducers that detect the presence and amount of body sway while the patient attempts to stand upright. The testing can be done under various conditions, including with the platform stationary or moving, flat or tilted, and with the patient's eyes open or closed, which can help isolate the contribution of the vestibular system to balance.
Primary imaging tests include CT of the temporal bone with or without radiopaque dye and gadolinium-enhanced MRI of the brain, the latter with attention paid to the internal auditory canals to rule out a vestibular schwannoma Vestibular Schwannoma A vestibular schwannoma, also called an acoustic neuroma, is a Schwann cell–derived tumor of the 8th cranial nerve. Symptoms include unilateral hearing loss. Diagnosis is based on audiology... read more . These tests may be indicated in cases of trauma to the ear, head, or both; chronic infection; hearing loss; vertigo; facial paralysis; and otalgia of obscure origin.
