Open Access Guide to Audiology and Hearing Aids for Otolaryngologists Clinical Assessment of Hearing: Free Field Voice Testing & Tuning Forks

Because of our ability to diagnose the majority of external and middle ear conditions by otoscopy, the history is often of little additional value in reaching a diagnosis. Thus in a patient with otoscopic evidence of chronic otitis media, the object of taking a history is not to make the diagnosis but to assess the resultant disability and to plan management. Equally, if an audiogram is available when a patient is seen, history taking is very different in those with sensorineural as opposed to conductive impairments. The temptation then is not to carry out the clinical assesment in the traditional order of history followed by examination. Indeed, the order of partial history, followed by otoscopy and clinical assessment of hearing, including audiometry, followed by further history has much to commend it.