The document describes aspects of a physical examination of the ear. It lists features that may be observed on the surface of the tympanic membrane, including vesicles, bullae, perforations of different sizes, and attic or marginal involvement. It also notes that normal tympanic membrane mobility can be assessed using Siegle's speculum. The document further describes degrees of nystagmus from first to third based on strength and presence when looking in different directions, and characteristics of central versus peripheral nystagmus including latency, duration, direction, fatiguability, and accompanying symptoms.

36. PHYSICAL EXAMINATION
FUNCTIONAL EXAMINATION

54. SURFACE OF TYMPANIC MEMBRANE
vesicles or bullae (herpes zoster or myringitis bullosa),
perforation (acute or chronic otitis media)
• central (in pars tensa)
• Small
• Medium
• Subtotal
• Total
• attic (in pars flaccida)
• marginal (at the periphery involving the annulus).
MOBILITY - Siegle's speculum
normal tympanic membrane is mobile.

74. 1st degree It is weak nystagmus and is present when patient looks in the direction of fast
component.
2nd degree It is stronger than the 1st degree nystagmus and is present when patient looks straight
ahead.
3rd degree It is stronger than 2nd degree nystagmus and is present even when patient looks in the
direction of the slow component.

75. CENTRAL PERIPHERAL
Latency No latency 2-20 seconds
Duration More than 1 minute Less than 1 minute
Direction of nystagmus Direction changing Direction fixed
Fatiguability Non-fatiguable Fatiguable
Accompanying symptoms None or slight Severe vertigo