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Ear Examination

How to examine the ear: ENT exams for doctors, medical student finals, OSCEs and MRCP PACES

Introduction

  • Wash hands
  • Introduce self
  • Explain examination and ask if the patient is in any pain
  • Ask them to tell you  if you cause them any discomfort with your examination

 

General Inspection

  • If wearing a hearing aid, advise the patient to remove it
  • Check for any asymmetry or if the patient presents with unilateral symptoms
  • Any evident congenital facies (e.g. Down’s syndrome)
  • Cauliflower ears may come from blunt trauma (sport contact)
  • Look for specific abnormalities
    • Tophi (gout)
    • Sebaceous cysts
    • Extra pinnae
    • Skin tags or a pre-auricular sinus
  •  Scars
    • Post auricular
    • Endaural
  • Discharge (e.g. wax or otorrhoea)
  • Inflammation or ulceration

 

Surface anatomy of the ear

Surface anatomy of the ear

Palpate

  • Pinnae
  • Post auricular region
  • Mastoid area
  • Front of the tragus (ask patient to open and close mouth)
  • Gently pull on the pinna (pain indicates there may be inflammation of the external auditory meatus [EAM])

 

Video on the ear examination and otoscopy

Otoscopy

  • Hold the otoscope like a pen between the thumb and index finger
  • Use your right hand for examination of the right ear and left hand for the left ear
  • Slowly insert around 1-1.5cm just past the hair of the lateral canal
  • Gently pull the pinna upwards, backwards and outwards
    • Be careful! This may cause the patient discomfort if they have inflammation in their EAM
  • Inspect the tympanic membrane
    • If bulging it may lose its bony landmarks and usually is a sign of pus in the middle ear
    • If retracted it will have accentuated bony landmarks and may signify a dysfunctional eustachian tube
  • Inspect for:
    • Discharge, scaling, inflammation, foreign bodies, stenoses, cerumen and exostoses
  • Check drum to ensure:
    • Not retracted
    • No perforations
    • Not bulging
    • Colour and translucency

 

The tympanic membrane as seen through an otoscope

The tympanic membrane as seen through an otoscope

Extra tests

  • Assess the patient’s hearing:
    • Ask if they have any hearing loss
    • Observe their ability to hear you during the examination
    • If hearing loss is suspected then the tuning fork, Rinne and Weber’s tests may be useful

 

Conclude the exam

  • Thank the patient
  • Make sure they are comfortable

 

Click here to learn about the nose examination and here to learn about other ENT examinations

Perfect revision for medical student finals, OSCES and PACES