Using an otoscope, this is a simple outpatient examination that provides information about the external auditory canal, the tympanic membrane and some aspects of the middle ear too.
Looking in ears and making a diagnosis is not easy, so practice every opportunity you have.
Below is a systematic method to make sure you can perform otoscopy rapidly and without missing anything.
Equipment for otoscopy
Otoscope with light
Multiple sized specula
Procedure for otoscopy
Start with the unaffected ear to get an idea of what is normal for this patient
Pick the largest speculum that will comfortably fit in the ear to ensure a good view.
Hold the otoscope like a pen and use your right hand for the patient’s right ear and left hand for the patient’s left ear.
Have your little finger extended to rest on the patient’s cheek to ensure you stay a constant distance away.
Have a quick look behind the ear and at the pinna for any scars or signs of infection.
Pull the pinna to straighten the canal and insert the otoscope gently. Then put your eye to the window to visualise.
Make sure you look at the EAC on your way in for infection/stenosis.
Once you can see the drum, ask yourself is it intact, is it of a normal colour, is it bulging or retracted, can you see fluid behind the drum, does the drum look particularly thin and see-through, are there white patches suggestive of tympanosclerosis?
Follow the routemap below to visualise every aspect of the drum:
Handle of malleus
Lateral process of malleus
Attic – very important to visualise for cholesteatoma
