The base of the vibrating tuning fork is placed any where on the middle of the skull or mandible. In subjects with normal hearing sound will be equally heard on both sides. But in patients with conduction deafness, sound is better heard on the affected side. This is due to absence of masking by air conducted sounds. In cases of sensory neural deafness the sound is better heard in the normal side.
Ask the subject whether he has tinnitus or vertigo. Look for nystagmus also. Abnormal auditory sensations:
(a) Tinnitus: The patient may complain of ringing sound in the ears.
(b) Hyperacusis: A disorder in which even slight sounds are heard with painful intensity.
(c)Auditory hallucinations: Common in Schizophrenia or in temporal lobe epilepsy.
IX. Glossopharyngeal Nerve: has sensory and motor functions
1. Taste sensations on the posterior one third of the tongue are tested.
2. Sensations in mucous membrane of soft palate and pharynx are tested using a cotton swab.
Pharyngeal reflex is tested: Touch the posterior pharyngeal wall using a cotton swab. Reflex contraction of pharyngeal muscles occur.
X. Vagus nerve: is a mixed nerve.
1. Ask the subject whether there is any nasal regurgitation of fluids during swallowing. This occurs in paralysis of
2. Listen for any nasal twang of voice.
3. Seat the subject facing good light with mouth open and protrude the tongue and look for any deviation of uvula.
Ask him to say ‘Ah’ Observe whether both sides of palate arch upwards during phonation. On paralysed side it
remains flat and immobile.
4. In bilateral laryngeal involvement, voice becomes deep and hoarse. Laryngeal stridor, or respiratory obstruction
XI. Accessory Nerve is purely motor in function
1. Ask the subject to shrug his shoulders against resistance offered by examiner pressing downwards
on the shoulders. (trapezius)
2. Ask the subject to turn his head to one side against resistance applied by the examiner, pressing on
the chin towards the opposite side. Involvement of the nerve causes weakness of rotation of chin towards
opposite side. i.e directed to the side of lesion. (sternocleidomastoid)
XII. The Hypoglossal Nerve
Purely motor, supplying the tongue and the depressors of the hyoid bone,
1 . Ask the subject to put out his tongue as far as possible. The tongue is pushed over to the paralysed side in XII
2. Ask the subject to move his tongue from side to side and to lick each cheek with it. Observe whether he can
do so correctly.
3. As the subject presses with his tongue on to the cheek, press on the cheek with the finger from outside and
assess the strength of the tongue muscle.
4. Note whether there is any wasting of the tongue which is observed in lower motor neuron lesion of the XII
5. Look for any fasciculation, with the tongue inside the mouth.
6. Note for any tremor of the tongue. This is common in Parkinson’s disease.
Trace the visual, auditory and taste pathways.
Kumkum / safron - Crocus sativus
Crocuses belong to the family Iridaceae. The saffron crocus is classified as Crocus sativus, It is a shrub. Leaves are seen towards the base of the stem and are compactly arranged.Read More about safron.....