(3) Conduct the Weber test. This test is used to determine hearing loss in
one ear. The procedure consists of striking a tuning fork and holding one end against
the middle of the patient's forehead. Ask the patient if he can hear the sound the same
or better in one ear than the other. If the patient says the same, his hearing is the same
in both ears. If the patient hears the sound best in the ear with poorer hearing, he has
conductive hearing loss. If he hears the sound best in the good ear, he has perceptive
(nerve) hearing loss.
(4) Conduct the Rinne test. The Rinne test also determines conductive or
nerve hearing loss.
(a) Procedure. The test is conducted in this manner. Strike the tuning
fork and place one end against the mastoid process of one ear. Note the length of time
the patient can hear the sound. Without striking the fork again hold the fork end near
the ear, about one inch away. Again, note the length of time the patient can hear sound
from the tuning fork.
(b) Results. If the patient can hear the sound twice as long when the
tuning fork is held against the mastoid process, he has normal hearing. If hearing in
both instances (tuning fork against the mastoid process and tuning fork held away from
the ear) is diminished with greater hearing when the fork is held away from the ear, the
patient probably has perceptive (nerve) hearing loss.
EXAMINATION OF NOSE/SINUSES
a. External Examination. Inspect the external nose and look for redness,
edema, lumps, tumors, or poor alignment. A patient with red nostrils may blow the nose
frequently because of allergies or infectious rhinitis. Dilated, engorged blood vessels of
the nose may indicate either that the patient is outside in all kinds of weather much of
the time or that he is an alcoholic. A person with a bulbous, discolored nose may have
rosacea (a chronic inflammatory disorder similar to acne).
b. Internal Examination. Follow these steps.
(1) Obtain patient history. Ask the patient about any previous olfactory
(2) Spread the nares. Do this by pushing on the tip of the patient's nose.
This gives a fair view of the inside of the nostrils.
(3) Examine with speculum with otoscope. Using a plastic funnel-type
speculum with otoscope, examine the septum and the turbinates. Check for polyps,