Chapter IV - ENT Procedures

Audiometry

The Heimlich Maneuver, also known as abdominal thrusts, is a first aid procedure for clearing an obstructed airway. It is an effective lifesaving measure in cases of choking. Dr. Henry Heimlich also has promoted it as a treatment for drowning and asthma attacks, but the practice of using the maneuver for these afflictions has not gained wide acceptance. Briefly, a person performing the Heimlich maneuver uses their hands to exert pressure on the bottom of the diaphragm. This compresses the lungs and exerts pressure on any object lodged in the trachea, hopefully expelling it. This amounts to an artificial cough. (The victim of an obstructed airway, having lost the ability to draw air into the lungs, has lost the ability to cough on their own.)

Rinne Test
Rinne test is performed to determine the smooth functioning of the sound conduction mechanism. By virtue of a normal sound conduction mechanism through the middle ear, air conduction will be greater than the bone conduction. To determine the sound conduction mechanism, a vibrating tuning fork is placed by the skull until the sound is lost. The prongs are then placed near the auditory orifice and a faint sound is again heard. A disorder of the sound conduction mechanism will make bone conduction greater than air conduction.

In short, Rinne test of hearing compares perception of sounds, as transmitted by air or by sound conduction through the mastoid.

In a normal ear, air conduction (AC) is better than bone conduction (BC)

AC > BC, positive Rinne.

In conductive hearing loss, bone conduction is better than air

BC > AC, negative Rinne.

In sensorineural hearing loss, bone conduction and air conduction are both equally depreciated, maintaining the relative difference of

AC > BC, positive Rinne.

In sensorineural hearing loss patients there may be a false negative Rinne

BC > AC,

If the normal ear is not masked, and bone conduction heard in the normal ear is reported as louder by the patient.

Weber Test
In the Weber test of hearing, a tuning fork is struck and placed on the patient's forehead. The patient is asked to report in which ear the sound is heard louder.

A normal patient would report that the sound is heard equally in both ears. A patient with a conductive hearing loss would hear the sound louder in the affected ear. This is because the affected ear cannot hear ambient noises as well because of its conductive hearing loss and so is effectively masked to these noises and able to focus more on the sound conducted through the skull. You can replicate this yourself by plugging one ear with your finger (i.e. mimicking a conductive hearing loss) and performing the Weber test on yourself.

A patient with a sensorineural hearing loss would hear the sound louder in the normal ear, because the affected ear is less effective at picking up sound even if is transmitted directly by conduction into the cochlea.

Drugs for the ears can be classified under four different categories: antibacterial, antifungal, anti-inflammatory, and anti-infective combinations, and drugs for wax removal. Antibacterial preparations are generally used in the treatment of inflammations in the external ear. Examples of such drugs are gentamicin and ciprofloxacin. Antifungal drugs are also known as antimycotic and they are antagonists to fungi. Clotrimazole is such an antimycotic, which is used in the treatment of otomycosis. Wax is a natural secretion in the ear. Sometimes, excess wax in the ear can cause deafness or block the view of the tympanic membrane. In such cases, removal of wax becomes a necessity. Ceruminolytic agents like Cerumenex are instilled, which emulsify and remove the wax. Pharmacology Aural preparations

Nasal Preparations
Nasal preparations can be divided into three broad categories: topical nasal decongestants, nasal anti-infectives, and nasal antiallergics. Topical nasal decongestants, like ephedrine are used to provide symptomatic relief from the nasal congestion. They act by achieving vasoconstriction and thereby relieving the congestion. Nasal antiallergics, mostly corticosteroids, exert their action by the stabilization of the mast cel1s.