Review the past medical history for any similar symptoms and for any chronic medical conditions that may predispose to this complaint. Also perform a neck exam and a brief neurologic exam with attention to gait, cranial nerves, and the presence or absence of positional nystagmus. Examination of the ear begins with several simple clinical tests to evaluate the presence or absence of hearing loss. Hearing loss is divided into conductive and sensorineural. Lesions in the sound conducting system, which includes the ear canal and drum, middle ear, and ossicles, cause a conductive loss.
Sensorineural loss is secondary to abnormalities of the vestibulocochlear system.
Begin with the voice test by occluding one ear while whispering or rubbing fingers together and repeat for the other side. Hearing is likely normal if the patient can pass these tests. Rinne's test evaluates conductive hearing loss by use of a 512 Hz tuning fork. The tuning fork is struck, placed on the mastoid process, and then 1 to 2 inches away from the ear. The patient is asked which was louder.