Clinical examination of the neck and salivary glands
Clinical examination of the larynx
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A. History Taking in Patients with Ear Disease
In much of medicine, but no more so than in Otolaryngology, the General Practitioner can and must obtain vital clues from an adequate clinical history, before examining the patient. Many relevant features of a good history are noted in the following sections.
The following symptoms referable to the ear should be recorded, taking note of their severity and their duration:
1. Hearing Loss
A “sensorineural hearing loss” implies damage to the inner ear or nerve.
Regardless of the cause, the deafness may be of a degree so slight or more typically of an onset so gradual as to escape the patient's notice and someone else notices the deafness first. In fact usually by the time the patient perceives a problem, the hearing loss can be quite significant, so asking family or friends about the patient’s hearing is important.
Additional features in the history of hearing loss:
Sudden hearing loss may occur in a number of circumstances, for example following barotrauma (flying or diving), upper respiratory tract infection, exposure to excessive noise or blasts, drug administration (e.g. gentamicin) or head injury.
Unilateral losses are more likely to have a specific cause (e.g. acoustic neuroma or vascular). Deafness due to age or noise exposure is bilateral and usually symmetrical.