Diagnostics

Before the examination the nasal lining is briefly sprayed: the spray makes the mucosa swell down slightly and numbs the surface. The flexible endoscope is then gently passed along the floor of the nose. This allows the septum, the turbinates, the narrow passages to the sinus openings and the nasopharynx to be assessed. The throat and larynx can be viewed afterwards.

Endoscopy reveals areas that cannot be seen from outside: swollen mucosa, narrowings, polyps, mucus tracks, changes at the Eustachian tube opening and findings at the larynx. If needed, cell material can be collected during the examination.

In chronic rhinosinusitis, a clear endoscopic finding can shorten further work-up: according to a specialist review, computed tomography is not necessarily required when nasal endoscopy is positive. Whether imaging is needed is decided by the physician based on findings and course.

In persistent hoarseness, viewing the larynx is part of the work-up: the international guideline on dysphonia recommends visualising the larynx when hoarseness lasts longer than four weeks. Mobility, position and surface of the vocal folds can be assessed endoscopically; additional methods exist for the fine movement of the vocal folds.

Headphones present tones at different pitches and volumes. You indicate when you hear a tone. The results form an audiogram showing hearing thresholds. Bone-conduction testing may be added when needed.

You listen to words or numbers and repeat what you understood. The test measures speech recognition at different sound levels; testing in background noise may be added depending on the clinical question.

A probe in the ear canal briefly changes air pressure and measures eardrum and middle-ear mobility. It can indicate middle-ear fluid or ventilation problems, but does not directly measure hearing ability.

A small probe records faint sound responses from the cochlea after a sound stimulus. This objective measurement provides information about outer hair cell function. Middle-ear problems can affect the result; OAEs alone do not rule out every hearing disorder.

Two tones are presented together. The probe measures additional sound responses generated in the cochlea. DPOAEs allow frequency-specific assessment of outer hair cell function.

Brief sounds, usually clicks, produce measurable cochlear responses. The standard abbreviation is TEOAE. The method is used in hearing screening, among other applications, and complements other hearing tests.

Skin electrodes record electrical responses along the auditory pathway to the brainstem after sound stimulation. Varying the sound level allows hearing thresholds to be estimated. The test requires quiet rest and is particularly helpful when reliable behavioural responses cannot be obtained.

Electrodes record sound-evoked electrical potentials from the cochlea and adjacent auditory nerve. Electrode placement depends on the technique and is explained beforehand. The measurement can support selected inner-ear assessments, but does not by itself establish a diagnosis of Ménière’s disease.

Tinnitus is the perception of a sound without an external source. Determining it includes an accurate description of the sound and measurement of its pitch and loudness: in tinnitus matching, a comparison tone is adjusted until it matches the sound you perceive. The level at which a noise covers the tinnitus fully or partly can also be recorded.

Because tinnitus frequently occurs together with hearing loss, pure-tone and speech audiometry form part of the assessment. Standardised questionnaires record how far the tinnitus affects daily life and make changes over time comparable. These measurements describe the tinnitus but do not by themselves reveal its cause. A newly developed, one-sided or pulsating tinnitus, and tinnitus with sudden hearing loss, should be assessed by a clinician promptly.

With the examination team ensuring your safety, you step in place with your eyes closed. Rotation or deviation is observed. This is a screening adjunct and cannot reliably localise a balance disorder on its own.

The team observes your stance with your feet close together, first with your eyes open and then closed. Changes in stability provide information about how sensory systems work together. The test is not specific to inner-ear disease.

Sound or vibration stimuli evoke reflex responses recorded by skin electrodes over a contracted neck muscle. cVEMPs primarily assess the saccule and associated vestibular reflex pathways.

Electrodes below the eyes record reflex responses to sound or vibration while you look upwards. oVEMPs primarily provide information about the utricle and associated reflex pathways. Both VEMP methods complement other balance examinations.

In videonystagmography, goggles with built-in cameras record your eye movements. The examination has several parts: following target lights, testing rapid eye movements (saccades), positional testing in different head positions and – if the clinician requests it – caloric testing, in which warm or cool airflow briefly triggers a spinning sensation. The direction, shape and strength of these eye movements indicate whether the balance organ on one or both sides responds abnormally.

The VNG is painless and usually takes one to two hours. Before the test, avoid make-up, alcohol and caffeine. Certain medications can affect the result; ask your clinician beforehand whether any should be paused, and do not stop anything on your own. Brief light-headedness or nausea can occur, so arranging a ride home is advisable.

In the ocular counter-roll test, video goggles record how the eyes rotate when the head or body is tilted sideways: they turn slightly in the opposite direction as a reflex. The measurement provides information about the otolith-mediated perception of gravity and body orientation, mainly of the utricle. It complements other balance examinations, does not replace imaging and is not needed for every form of dizziness.

In transcranial magnetic stimulation, a coil held over the head delivers brief magnetic pulses that activate the cerebral cortex, and electrodes record the resulting muscle responses. In ENT care the method has so far been used mainly in research, to study connections between the balance organs and the brain. It is not part of routine diagnostics in an ENT clinic and is relevant chiefly for neurological or scientific questions.

Contraindications must be clarified before use, for example epilepsy, a brain stimulator or metal implants in the head area. Whether such an examination is needed at all is decided by a clinician after clinical assessment; it is carried out in neurology or research departments equipped for it.

For the head impulse test you keep your gaze on a fixed point while the clinician quickly and gently turns your head to the left or the right. If balance function is intact, the eyes follow this movement automatically without losing the target. If the movement is not compensated, the eye makes a small corrective movement – an indication that the balance organ on that side may be working less well.

In the video-assisted form (vHIT), the eye movements are recorded with small goggles. This allows the gaze-following response to be measured for each individual semicircular canal, and even small corrective movements are detected. The test takes only a few minutes and complements other examinations such as caloric testing – it does not replace them.

While you swallow, a controlled air pressure is applied through the nose. A measurement at the ear assesses whether and when the Eustachian tube opens and transmits pressure to the middle ear. Results are considered alongside symptoms, eardrum findings and other tests; this measurement alone does not prove or exclude Eustachian tube dysfunction.

Active anterior rhinomanometry measures air pressure in front of the nostril and the airflow while you breathe normally. Both values are used to calculate the resistance of nasal breathing, separately for the right and left side. The figure shows how easy or how laboured breathing is at that moment. Results depend on how swollen the nasal lining currently is and can change over the day; they are interpreted alongside your symptoms and the endoscopic findings.

Rhinoresistometry records nasal resistance continuously across the breathing cycle rather than as a single figure. This shows how resistance changes during inhalation and exhalation. The display can indicate an unstable nasal airway that narrows while you breathe. It too cannot by itself establish where a narrowing lies, and is interpreted together with endoscopy and rhinomanometry.

Acoustic rhinometry – sometimes called acoustic rhinomanometry – works with sound pulses: a brief tone is sent into the nose and a device calculates, from the returning echoes, how large the cross-section of the nasal cavity is at different distances. This provides the narrowest cross-sectional area and the volume of the nasal cavity. The method describes the shape of the nasal airway, but not airflow or resistance, and is therefore often combined with rhinomanometry.

For the FeNO measurement you breathe calmly and steadily into a small device, which analyses the proportion of nitric oxide (NO) in your exhaled breath. The test is non-invasive, takes only a few minutes and complements lung function testing – it does not replace it.

An elevated value can point to a particular type of airway inflammation, as seen for example in allergic asthma. In adults a value below 25 ppb is considered low and a value above 50 ppb high. The FeNO value alone does not establish a diagnosis; the medical team interprets it together with the examination, lung function and other findings.

Before treatment, the specific indication, possible contraindications and ability to equalise pressure are assessed. Risks include pressure injuries to the ears and sinuses; other adverse effects are also possible. Benefits, alternatives, the procedure and cost coverage are discussed in advance. The team clarifies whether and where chamber treatment can be arranged.

Three aspects are tested: recognising odours (identification), telling similar odours apart (discrimination) and the lowest concentration that can still be detected (threshold). Standardised test sets – for example scent pens or scent cards – provide comparable results that are checked against age references. The test requires reasonably free nasal breathing; during a cold or immediately after a decongestant nasal spray it is repeated at another time.

For the basic qualities sweet, sour, salty, bitter and umami, solutions or impregnated test strips are applied to the tongue and named. Because much of what we experience as taste arises via the nose (retronasal olfaction), smell is usually tested as well when taste is the complaint.

Assessment is useful when the sense of smell weakens or is lost, after respiratory infections or head injuries, with nasal polyps or chronic sinus inflammation, and for selected neurological questions. Whether and how an olfactory disorder can be treated depends on the cause. In advance, the team clarifies which examination is needed and whether it takes place here or in a specialist facility.

For testing, cell material is collected with a small brush or spatula. The collection is quickly done and usually described as well tolerated; the material reaches the laboratory in a carrier fluid.

In the laboratory the viral DNA is usually detected by PCR. At the same time it can be determined whether a high-risk or a low-risk type is present. This result influences further work-up and the follow-up intervals.

Besides the anogenital region, high-risk types can also affect the oral cavity and pharynx. A substantial share of squamous cell carcinomas of the mouth and throat is caused by an HPV infection. Abnormal findings in this area are therefore medically evaluated.

Detecting viral DNA by PCR is regarded as the standard method for herpes simplex and varicella zoster viruses: it is particularly sensitive and specific, usually delivers results within 24 hours and distinguishes the virus types from one another.

Antibody tests in the blood indicate a past or current encounter with the pathogen but are less precise for dating it. Virus culture and direct fluorescence labelling work mainly in early lesions.

A test is especially helpful when therapy depends on it – for example in facial herpes zoster, in sudden hearing or balance changes with blisters, in suspected virus-related facial palsy, or in smell and taste disorders after infections. The decision is made by the examining physician based on findings and course.

For a resting ECG you lie relaxed on a couch. Small electrodes are attached to the chest, arms and legs and connected by cables to the ECG device; the recording takes only a few minutes.

The deflections of the curve follow the heart’s sequence of excitation. From their height, steepness, duration and time intervals, rhythm, rate and disturbances of impulse formation can be assessed.

Before an anaesthetic and an inpatient stay, the question of the heart’s capacity for strain is part of the work-up. In cases of racing heart, palpitations, dizziness or breathlessness the ECG is supplemented – where appropriate by a long-term or exercise ECG.

After a short instruction you breathe in deeply and blow the air out into the mouthpiece as forcefully and as long as possible. The measurement is repeated several times; it usually takes less than ten minutes.

The main measures are the amount of air exhaled in the first second (FEV1) and the total amount exhaled (FVC). From their ratio, physicians can tell whether the airways are narrowed or the lung volume is reduced.

Reasons include unexplained breathlessness, persistent cough or sputum, follow-up in asthma or COPD, and risk assessment before an operation. Within sleep medicine, lung function can also be assessed as a complement.