Thorough Ear History and Exam

Hearing loss, “ringing” in the ears, and dizziness/vertigo are three of the most common things I’ve seen in the ENT clinic, and a proper workup during the initial encounter can provide valuable information regarding the etiology. In the case of unilateral or asymmetric pathology, the question that always arises: “Why is one ear affected more than the other?”

This is where we need to step beyond the bounds of medicine to explore one’s social history in depth. If a patient was in the military, were they exposed to loud sounds (exploding TNT, firearms, working the flight deck, etc.)? Not only that, but did the patient have a tendency to fire pistols or rifles from the same hand, thereby always having one ear exposed to louder noises than the other? This is just one example, but here are some other questions I routinely ask:

• Any history of ear trauma, surgery, or recent infection?
• When did the symptoms start? Did they get worse? Over how much time did they get worse? Are they worse during a certain time of day or when your body is in a certain position? Are you aware of anything that makes the symptoms better or worse in general?
• Have you noticed a change in your gait? In other words, do you find yourself wobbling around as you walk, or drifting to a certain direction (left or right) as you try to walk in a straight line?
• Do you ever feel “dizzy?” – if so, is it more like difficulty balancing yourself, or does it feel like the world is spinning around you?
• What kind of jobs have you had? Any prolonged exposure to loud noises?
• Do you use Q-tips to clean your ears? (any ENT doc will tell you this is a bad idea)

Now that my ENT rotation is over, I’m disheartened to be moving on from the amazing patients, procedures, and resident teaching I had over the last two weeks. Hopefully the next two weeks of ophthalmology (the last two weeks of this three month long surgery rotation) will end things on a good note! 🙂