Assess functional hearing with conversational or whispered voice from each side, observing the patient’s response and noting asymmetry.
Inspect the external ear and visible canal for deformity, swelling, drainage, or cerumen, where within scope.
Characterize any vertigo fully — spinning versus light-headedness, positional triggers, duration, and associated nausea — and screen for the neurologic signs that indicate a central cause.
For acute vertigo with any neurologic sign, apply the stroke pathway rather than attributing it to a peripheral cause.
Check hearing-aid fit, battery, and function and observe the patient inserting, removing, and cleaning the device.
Assess balance and gait where vestibular dysfunction is present, with a guard.
Confirm the communication strategy that works for the patient and ensure teaching is delivered in a way they can receive.
For cerumen management, perform only within scope and order, screening for contraindications such as a perforation or a tube.
