Two seconds of palpation, one correct pull on the pinna and a pearly grey drum will tell you where the problem lives — outside the drum, behind it, or past it in the nerve. Set the patient’s age and choose your traction, read a real tympanic membrane against its landmarks, then combine whisper, Weber and Rinne into a finding precise enough to phone in.
Patient age — 25 years
Which way do you pull the pinna?
Straightening the canal is what lets you see the drum without touching the canal wall.
Cerumen irrigation has been ordered. What else is true of this patient?
Tap every item that applies before you pick up the syringe.
Which ear?
What do you see through the otoscope?
Whispered voice screen
Stand about an arm’s length (roughly 60 cm) behind and to the side so the patient cannot read your lips. Occlude the other ear by pressing and gently rubbing the tragus. Exhale fully — that is what makes it a true whisper — then whisper three numbers and letters such as “4–K–2.”
Items repeated correctly, out of 6
Weber — 512 Hz fork on the midline skull
Rinne — mastoid, then 2 cm in front of the canal
Right ear
Left ear
History
Set the age, then choose your tractionThe bench grades the pull and explains the anatomy behind it.