otoscopy

Last reviewed 01/2018

The otoscope:

• should be held delicately but with full control. The hand holding the instrument should be steadied against the cheek, this prevents injury to the ear if the patient happens to move suddenly
• it can be held in either a pencil grip or a hammer grip (1)
• it should always be held in the hand of the same side as the ear about to be examined (1)
• the pinna should be gently retracted to straighten the ear canal - if this manoeuvre is painful one should suspect inflammatory conditions of the external ear
• if superficial wax is present in the outer canal (that can be easily removed) then this is removed to improve the visual field seen via otoscopy
• the whole of the tympanic membrane should be examined if possible
  • special attention should be payed to the superior part, the pars flaccida, as destructive ear disease may be apparent here.
• general steps to follow include:
  • to look at the external canal wall
  • visualization of the tympanic membrane
    • is the tympanic membrane intact?
    • is the colour and transparency of the tympanic membrane normal?

Pneumatic otoscopy:

• it is a diagnostic technique used to assess the tympanic membrane (2)
• it is the primary tool for diagnosing middle ear effusion in acute otitis media or otitis media with effusion.(3)
• it provides a qualitative measure of tympanic membrane mobility (3)
• a pneumatic attachment to the otoscope allows the mobility of the tympanic membrane to be assessed.
• the features that can be assesed are:
  • the landmarks
  • mobility
  • transparency
  • color
  • vascularity
  • position
• using pneumatic otoscopy (qualitative) with tympanometry (quantitative ) improves the accuracy of diagnosis (3)

Reference:

• (1) Simon Carney and John P Birchall.How to use an otoscope. Student BMJ.1995
• (2) Pneumatic Otoscopy:Virtual Classroom Of The American Academy Of Paediatrics
• (3) Edward Onusko. Tympanometry.Am Fam Physician 2004;70:1713-20