Diagnostic Tests for Acoustic neuroma
Acoustic neuroma: Diagnostic Tests
The list of diagnostic tests
mentioned in various sources as
used in the diagnosis of Acoustic neuroma
includes:
Acoustic neuroma Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Acoustic neuroma:
- Colon & Rectal Cancer: Home Testing
- Ear Infections: Home Testing:
- Brain & Neurological Disorders: Related Home Testing:
- Cancer-Related Home Testing:
Acoustic neuroma Diagnosis: Book Excerpts
Diagnostic Tests for Acoustic neuroma: Online Medical Books
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Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Acoustic neuroma.
Hearing loss:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient reports hearing loss, ask him to describe it. Is it unilateral or bilateral? Continuous or intermittent? Ask about a family history of hearing loss. Then obtain the patient’s medical history, noting chronic ear infections, ear surgery, and ear or head trauma. Has the patient recently had an upper respiratory tract infection? After taking a drug history, have the patient describe his occupation and work environment.
Next, explore associated signs and symptoms. Does the patient have ear pain? If so, is it unilateral or bilateral, or continuous or intermittent? Ask the patient if he has noticed discharge from one or both ears. If so, have him describe its color and consistency, and note when it began. Does he hear ringing, buzzing, hissing, or other noises in one or both ears? If so, are the noises constant or intermittent? Does he experience dizziness? If so, when did he first notice it?
Begin the physical examination by inspecting the external ear for inflammation, boils, foreign bodies, and discharge. Then apply pressure to the tragus and mastoid to elicit tenderness. If you detect tenderness or external ear abnormalities, notify the physician to discuss whether an otoscopic examination should be done. (See Using an otoscope correctly, page 237.) During the otoscopic examination, note color change, perforation, bulging, or retraction of the tympanic membrane, which normally looks like a shiny, pearl gray cone.
Next, evaluate the patient’s hearing acuity, using the ticking watch and whispered voice tests. Then perform Weber’s and the Rinne tests to obtain a preliminary evaluation of the type and degree of hearing loss. (See Differentiating conductive from sensorineural hearing loss, page 316.)
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Costovertebral angle tenderness:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
After detecting CVA tenderness, determine the possible extent of renal damage. First, find out if the patient has other symptoms of renal or urologic dysfunction. Ask about voiding habits: How frequently does he urinate, and in what amounts? Has he noticed any change in intake or output? If so, when did he notice the change? (Ask about fluid intake before judging his output as abnormal.) Does he have nocturia? Ask about pain or burning during urination or difficulty starting a stream. Does the patient strain to urinate without being able to do so (tenesmus)? Ask about urine color; brown or bright red urine may contain blood.
Explore other signs and symptoms. For example, if the patient is experiencing pain in his flank, abdomen, or back, when did he first notice the pain? How severe is it, and where is it located? Find out if the patient or a family member has a history of urinary tract infections, congenital anomalies, calculi, or other obstructive nephropathies or uropathies. Also, ask about a history of renovascular disorders such as occlusion of the renal arteries or veins.
Perform a brief physical examination. Begin by taking the patient's vital signs. A fever and chills in a patient with CVA tenderness may indicate acute pyelonephritis. If the patient has hypertension and bradycardia, be alert for other autonomic effects of renal pain, such as diaphoresis and pallor. Inspect, auscultate, and gently palpate the abdomen for clues to the underlying cause of CVA tenderness. Be alert for abdominal distention, hypoactive bowel sounds, and palpable masses.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Hearing loss:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient reports hearing loss, ask him to describe it fully. Is it unilateral or bilateral? Continuous or intermittent? Ask about a family history of hearing loss. Then obtain the patient’s medical history, noting chronic ear infections, ear surgery, and ear or head trauma. Has the patient recently had an upper respiratory tract infection? After taking a drug history, have the patient describe his occupation and work environment.
Next, explore associated signs and symptoms. Does the patient have ear pain? If so, is it unilateral or bilateral? Continuous or intermittent? Ask the patient if he has noticed discharge from one or both ears. If so, have him describe its color and consistency, and note when it began. Does he hear ringing, buzzing, hissing, or other noises in one or both ears? If so, are the noises constant or intermittent? Does he experience any dizziness? If so, when did he first notice it?
Begin the physical examination by inspecting the external ear for inflammation, boils, foreign bodies, and discharge. Then apply pressure to the tragus and mastoid to elicit tenderness. If you detect tenderness or external ear abnormalities, ask the physician whether an otoscopic examination should be done. (See Using an otoscope correctly, page 289.) During the otoscopic examination, note any color change, perforation, bulging, or retraction of the tympanic membrane, which normally looks like a shiny, pearl gray cone.
Next, evaluate the patient’s hearing acuity, using the ticking watch and whispered voice tests. Then perform the Weber and Rinne tests to obtain a preliminary evaluation of the type and degree of hearing loss. (See Differentiating conductive from sensorineural hearing loss.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Costovertebral angle tenderness:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
After detecting CVA tenderness, determine the possible extent of renal damage. First, find out if the patient has other symptoms of renal or urologic dysfunction. Ask about voiding habits: How frequently does he urinate and in what amounts? Has he noticed any change in intake or output? If so, when did he notice it? (Ask about fluid intake before judging his output as abnormal.) Does he have nocturia, pain or burning during urination, or difficulty starting a stream? Does the patient strain to urinate without being able to do so (tenesmus)? Ask about urine color; brown or bright red urine may contain blood.
Explore other signs and symptoms. For example, if the patient is experiencing pain in his flank, abdomen, or back, when did he first notice it? How severe is it, and where is it located? Find out if the patient or a family member has a history of urinary tract infections, congenital anomalies, calculi, or other obstructive nephropathies or uropathies. Also, ask about a history of renovascular disorders, such as occlusion of the renal arteries or veins.
Perform a brief physical examination. Begin by taking the patient’s vital signs. Fever and chills in a patient with CVA tenderness may indicate acute pyelonephritis. If the patient has hypertension and bradycardia, be alert for other autonomic effects of renal pain, such as diaphoresis and pallor. Inspect, auscultate, and gently palpate the abdomen for clues to the underlying cause of CVA tenderness. Be alert for abdominal distention, hypoactive bowel sounds, and palpable masses.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Hearing Loss:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
Gross tests of hearing are only helpful to confirm significant hearing asymmetry or to detect profound hearing loss. With one ear covered, the patient tries to hear soft sounds such as the tick of a watch, scratching of two fingers rubbed together, or a softly whispered voice.
A. Visual examination of ears. Inspect the canal and TM to rule out obvious causes of CHL. Cerumen impaction is a remarkably common and easily corrected cause of hearing loss. Pneumoscopy to check for normal movement of the TM helps rule out perforation, atelectasis, eustachian tube dysfunction, stiffened TM, ossicular disruption, and middle ear effusion.
B. Weber test. With a vibrating tuning fork placed on the top of the head, the patient is asked to describe the sound heard. The patient will perceive the sound to be louder in the affected ear in CHL, because the background noise will be absent on that side. The unaffected ear will be perceived as louder in SNHL.
C. Rinne test. With the vibrating tuning fork placed on the mastoid, the patient detects bone conduction (BC). The tuning fork is removed when the patient can no longer hear the sound. Then the tuning fork is held next to the ear to test for air conduction (AC). In an individual with normal hearing, AC is significantly better than BC. CHL will reduce AC, with little effect on BC.
Testing
A simple audiogram performed at several frequency responses may detect individuals at risk for hearing loss. Although the sensitivity is good (93% to 95%), the poor specificity (60% to 74%) can result in many false-positive findings (3).
A. Audiography. Two forms of testing provide reproducible information about the patient. Pure tone testing documents the exact number of decibels heard at a given frequency. Unfortunately, it describes nothing about the ability to discriminate language. On the other hand, speech detection better estimates impairment of actual language function, but requires a much more cooperative and attentive patient.
B. Auditory-evoked response. Able to detect the electroencephalographic stimulation caused by repetitive sounds, this examination is useful in the obtunded, uncooperative, or very young patient.
C. Computed tomography (CT). In the setting of traumatic loss of hearing, CT is fast, less expensive than magnetic resonance imaging (MRI), and able to detect abnormalities within the petrous ridge where fractures can affect hearing (4). Likewise, bleeding in the CNS is readily seen. CT is also useful to examine for causes of CHL such as tumors, middle ear anomalies, myringosclerosis, and cholesteatoma.
D. MRI. In patients with SNHL, MRI with gadolineum is superior to CT because certain CNS diseases (MS or vascular infarcts) are more easily identified. In addition, acoustic neuromas and labyrinth disorders, often too small to be seen with CT, may be visualized with MRI (4).
Diagnostic assessment
Separation into CHL and SNHL, and assessment of severity help determine the best diagnostic approach (2).
A. Conductive hearing loss. Although bothersome, these disorders are rarely severe or life threatening. Systematic history and physical examination normally will easily localize the site of hearing loss.
B. Sensorineural hearing loss. Acoustic neuroma (AN), one of the most feared causes of hearing loss, is actually a nerve sheath tumor accounting for 1% of SNHL; 95% of patients with AN present with gradual progression of unilateral hearing loss (4). Tinnitus and vestibular symptoms are less common. In contrast, Ménière’s disease causes a fluctuating but progressive loss of hearing associated with tinnitus and episodic vertigo. Other causes of SNHL can be severe, rapidly progressive, and associated with severe side effects or potential mortality. Rapid systematic evaluation, including MRI in patients aged less than 65 years, should be conducted. For patients over the age of 65 years, exclusion of presbycusis and otosclerosis should prompt the same thorough evaluation.
References
1. Maggi S, Minicuci N, Martini A, et al. Prevalence rates of hearing impairment and comorbid conditions in older people: the Veneto Study. J Am Geriatr Soc 1998;46:
1069–1074.
2. Weber P, Klein A. Hearing loss. Med Clin North Am 1999;83:125–137.
3. Weissman J. Hearing loss. Radiology 1996;199:593–611.
4. Moore A, Siu A. Screening for common problems in ambulatory elderly: clinical confirmation of a screening instrument. Am J Med 1996;100:438–443.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Hearing Loss:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Conductive hearing loss presents with loss of low tones and vowels. Sensorineural hearing loss produces impaired high tone perception, with diminished speech discrimination—especially for female voices—and hearing ringing sounds (tinnitus). Hyperacusis (the sensation that sounds are overly loud to the point of discomfort) is associated with sensorineural cochlear hearing loss. Paracusis (words perceived more clearly in a noisy environment) is associated with conductive middle ear hearing loss.
A reliable qualitative screen for high frequency hearing loss is the ability to hear whispered speech. Stand behind the patient at arm’s length and test one ear at a time. Whisper a combination of 3 letters and numbers (e.g., 4-K-2), and ask the patient to repeat it. The screen is passed when 3/6 are correctly identified. The 256 Hz tuning fork tests 10 to 15 dB, and the 512 Hz 20 to 30 dB. The Rinne test (bone conduction . air conduction) is sensitive to a 20 dB hearing loss. The Weber test is sensitive to 5 dB of hearing loss. A tuning fork is placed in the midline. With conductive loss, it lateralizes to the affected ear, and with sensorineural loss, to the unaffected ear.
Pneumoscopy is performed by first insufflating the ear then releasing. A nonmobile TM may be due to fluid or a mass in the middle ear cavity, or a stiff or sclerotic TM. A hypermobile TM may indicate ossicular chain disruption. A TM that moves only with negative pressure can be due to a retracted TM or a middle ear with a blocked eustacian tube, with resulting negative ear pressure.
Acute hearing loss occurs with infection, traumatic tympanic membrane rupture, or acute vascular event. Unilateral sensorineural loss suggests an inner ear disorder such as Meniere disease or an acoustic neuroma.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Hearing loss:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Begin the physical examination by inspecting the external ear for inflammation, boils, foreign bodies, and discharge. Then apply pressure to the tragus and mastoid to elicit tenderness. If you detect tenderness or external ear abnormalities, notify the physician to discuss whether an otoscopic examination should be done. During the otoscopic examination, note any color change, perforation, bulging, or retraction of the tympanic membrane, which normally looks like a shiny, pearl gray cone.
Next, evaluate the patient’s hearing acuity, using the ticking watch and whispered voice tests. Then perform the Weber’s and Rinne tests to obtain a preliminary evaluation of the type and degree of hearing loss. (See Differentiating conductive from sensorineural hearing loss, page 330.)
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Costovertebral angle tenderness:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Perform a brief physical examination. Begin by taking the patient’s vital signs. Fever and chills in a patient with CVA tenderness may indicate acute pyelonephritis. If the patient has hypertension and bradycardia, be alert for other autonomic effects of renal pain, such as diaphoresis and pallor. Inspect, auscultate, and gently palpate the abdomen for clues to the underlying cause of CVA tenderness. Be alert for abdominal distention, hypoactive bowel sounds, and palpable masses.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Hearing Loss and Deafness:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Auditoryand language findings listed in Table26.1 are indications for possible hearing loss or deafness.Suspected hearing loss should be investigatedto determine the type, severity, and cause.Any child with suspected hearing lossshould be referred for audiologic evaluation. Speech and languageassessment is often necessary. Neurologic and otolaryngologic consultationmay be required, depending on suspected problem.
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Hearing loss:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient reports hearing loss, ask him to describe it. Is it unilateral or bilateral? Continuous or intermittent? Ask about a family history of hearing loss. Then obtain the patient's medical history, noting chronic ear infections, ear surgery, and ear or head trauma. Has the patient recently had an upper respiratory tract infection? After taking a drug history, have the patient describe his occupation and work environment.
Next, explore associated signs and symptoms. Does the patient have ear pain? If so, is it unilateral or bilateral, or continuous or intermittent? Ask the patient if he has noticed discharge from one or both ears. If so, have him describe its color and consistency, and note when it began. Does he hear ringing, buzzing, hissing, or other noises in one or both ears? If so, are the noises constant or intermittent? Does he experience dizziness? If so, when did he first notice it?
Begin the physical examination by inspecting the external ear for inflammation, boils, foreign bodies, and discharge. Then apply pressure to the tragus and mastoid to elicit tenderness. If you detect tenderness or external ear abnormalities, notify the physician to discuss whether an otoscopic examination should be done. (See Using an otoscope correctly, page 223.) During the otoscopic examination, note color change, perforation, bulging, or retraction of the tympanic membrane, which normally looks like a shiny, pearl gray cone.
Next, evaluate the patient's hearing acuity, using the ticking watch and whispered voice tests. Then perform Weber's and the Rinne tests to obtain a preliminary evaluation of the type and degree of hearing loss. (See Differentiating conductive from sensorineural hearing loss, page 304.)
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Costovertebral angle tenderness:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
After detecting CVA tenderness, determine the possible extent of renal damage. First, find out if the patient has other symptoms of renal or urologic dysfunction. Ask about voiding habits: How frequently does he urinate, and in what amounts? Has he noticed any change in intake or output? If so, when did he notice the change? (Ask about fluid intake before judging his output as abnormal.) Does he have nocturia? Ask about pain or burning during urination or difficulty starting a stream. Does the patient strain to urinate without being able to do so (tenesmus)? Ask about urine color; brown or bright red urine may contain blood.
Explore other signs and symptoms. For example, if the patient is experiencing pain in his flank, abdomen, or back, when did he first notice the pain? How severe is it, and where is it located? Find out if the patient or a family member has a history of urinary tract infections, congenital anomalies, calculi, or other obstructive nephropathies or uropathies. Also, ask about a history of renovascular disorders such as occlusion of the renal arteries or veins.
Perform a brief physical examination. Begin by taking the patient's vital signs. A fever and chills in a patient with CVA tenderness may indicate acute pyelonephritis. If the patient has hypertension and bradycardia, be alert for other autonomic effects of renal pain, such as diaphoresis and pallor. Inspect, auscultate, and gently palpate the abdomen for clues to the underlying cause of CVA tenderness. Be alert for abdominal distention, hypoactive bowel sounds, and palpable masses.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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