Section 3 - Adult health checks

Health check recommendations

• All adults > 15 years of age if clinically indicated
• All Aboriginal and Torres Strait Islander > 15 years of age annually

1. Procedure

• Ask the questions and perform the corresponding procedure. See Table 1.
• Provide brief intervention as required
• Determine if the person requires a referral and place on a follow-up and recall register. See Flowchart 1.

1. Performing otoscopy ^1–3
   • Otoscopy is the visual examination of the ear canal and eardrum. See Figure 1.
   • If there is pain or notable discharge from the ear(s) do not proceed. Refer to the Primary Clinical Care Manual
   • Observe the bone behind the ear (mastoid) and the area under the ear for infection, swelling or tenderness
   • Check the pinna for size, shape, colour or lesions
   • Observe the ear canal for:
     • discharge
     • redness/swelling
     • fungal infections
     • lumps or bony growths
     • foreign bodies
     • wax
     • fluid
   • Inspect the eardrum (tympanic membrane) for:
     • colour:
       • transparent and shiny is normal
       • dull or opaque represents fluid behind eardrum
     • cone of light (reflection):
       • right ear at 5 o’clock and left ear at 7 o’clock
       • reflections elsewhere indicates bulging
     • the handle of the malleus
     • perforations
     • abnormalities of the attic region e.g. perforation, mass, growth
   • Repeat procedure for the other ear

   Figure 1. Visual representation of the eardrums
   
   

Flowchart 1. Hearing health check review and referral procedure

1. Performing tympanometry ^1–3
   • Tympanometry is a test of middle ear function and measures:
     • ear canal volume (ECV)
     • middle ear pressure (daPa)
     • middle ear compliance or movement
     • See Resource 1. for further tympanometry support
   • If a person has had recent surgery, pain or if there is a perforation or discharge from the ear(s) do not proceed. Refer to the Primary Clinical Care Manual
   • A “Leak” or “Blockage” error can occur for many reasons:
     • clogged probe tip
     • probe tip too large or small
     • head movements or swallowing
     • probe tip against the ear canal wall
     • debris, foreign body or wax in ear canal
   • To rectify try:
     • a different sized probe tip
     • cleaning probe tip
     • reposition the probe tip in the ear canal

3. Performing audiometry ^1–3
   • Audiometry measures the ability of the ear to:
     • detect the pitch of a sound as hertz (Hz)
     • detect the loudness of a sound as decibels (dB)
   • Place headphones on patient. Test one ear at a time
   • Set hertz (Hz) dial to 4000 Hz and decibels (dB) to 50 dB. Test
   • The person ‘fails’ if they do not indicate they hear a sound
   • If the person indicates they can hear the sound then reduce to 35 dB and repeat
   • If the person indicates they can hear the sound then reduce to 25 dB and repeat
   • Repeat these steps until the person no longer responds
   • Record the lowest perceived dB the person responds to twice
   • Repeat for the other ear
   • Repeat the procedure for both ears at 2000 Hz and 1000 Hz
   • To ‘pass’, the person needs to respond twice to 25 dB at 1000, 2000 and 4000 Hz

2. Results

• All adults should have
  • clean ears, free of pain, discharge or infection
  • pass all tests and hear clearly

3. Brief intervention ^1–3

• Ear disease and hearing loss is high in Aboriginal and Torres Strait Islander adults, related to frequent childhood ear infections, contributing to poor education, unemployment and justice system contact
• Provide preventative information:
  • hand and face washing
  • regular nose blowing
  • avoid cigarette/vape smoke
  • avoid loud noises (e.g. earbuds or headphones)
  • only swim in running water or swimming pools
  • maintain healthy Diet and nutrition
  • avoid putting anything in the ears (including cotton buds)
  • if concerned present to health centre

4. Referral

• If you have any concerns about a person’s ability to hear refer to MO/NP and email Hearing Australia. See Resource 2–3.
• If the person has ear pain or discharge, manage according the Primary Clinical Care Manual

5. Follow-up

• Review as per Flowchart 1.
• Place the person on a recall register if required
• Ensure all referrals are actioned
• Provide the person with details for the next scheduled follow-up appointment

6. References

• All Chronic Conditions Manual references are available via the downloadable References PDF

7. Resources

1. Hearing Australia’s Tympanometry module for primary health providers
2. Hearing Australia email
3. Online referral to Hearing Australia