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Basics of otoscopy

  • 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
    • Anterosuperior drum
    • Anteroinferior drum
    • Posteroinferior drum
    • Posterosuperior drum
  • Repeat the procedure with the other ear.

Video on hoe to perform otoscopy from Oxford Medical Videos

Top tips for otoscopy

  • The portion of the EAC medial to the hair-bearing region is exquisitely sensitive. Be very careful and try not to touch the walls of the canal.
  • The junction and anatomy between the bony and cartilaginous portion of the EAC varies in adults and children
    • To straighten the canal in adults, gently pull the pinna upwards and backwards.
    • In children, pull the pinna directly backwards alone.


Click here to download free teaching notes on Otoscopy: Otoscopy

Perfect revision for medical students, finals, OSCEs and MRCP PACES