EXAMINATION OF THE EAR

December 9, 2013
Dr. D. Dominguez & Dr. MJ Tipayno-Lubos

EXAMINATION OF THE EAR

OTOSCOPY

Indications
o
Patients who complain of hearing
loss
o
Patients who complain of
otalgia/ear pain
o
Ear discharges
o
Unilateral ear problem

always check the normal

ear first
o
Any otologic complains or
symptoms

Should be part of a routine physical

examination
o
some systemic diseases have
otologic manifestations and vice
versa
Basic Tool:

Otoscope: direct light

o
Parts:

Handle

contains the
power of the light
source

Head

contains the light

bulb and
magnifying lens

Cone

inserted into the

ear canal

speculum

Head Mirror
o
indirect light source
o
used when a procedure requires
the use of both hands

i.e. foreign body

extraction

*To conduct a thorough examination of the ear, you

need to systematically inspect, palpate, examine
with an otoscope and carry out special tests.

Wash hands
Introduce yourself and ask permission to
examine the patient
Position the patient sitting down. Sit directly
opposite them so you are examining them
at eye level
Ask the patient if their hearing is better on
one side or the same in both (you should
examine the better side first). Also check if
they have any pain currently.

E.R.Sibayan
1

Inspect

Pinna, auricule, helix, antihelix

For any visible wax, discharge or bleeding
Preauricular sinuses
Behind the ear - any surgical/trauma scars?
Hearing aids
The meatus itself - wide?

Palpate

Tug gently on the pinna - any tenderness?

Press over the mastoid process - any

tenderness?

Palpate for any cervical or periauricular

lymphadenopathy
Otoscopy

Turn on the otoscope and ensure the light is

working

Put a plastic tip on the end of the otoscope

o
Appropriate to size of the ear

children need smaller tips

Gently hold the ear up and back to

straighten the ear canal (children have
straighter canals so you do not need to pull
the ear upwards)
o
Adults: postero-superiorly
o
Pedia: postero-inferiorly

Gently insert the otoscope

Look at the canal wall - any

wax/discharge/bleeding?

Tympanic membrane:
o
Perforation

Always describe the

perforation: percentage
and location

i.e. 50% central

perforation
o
Light reflex/bulging
o
Grommets
o
Cholesteatoma
o
Chalk deposits
o
Fluid bubbles (effusion)
Pediatric Patients

For infants and younger children, have the

child sit on the parents lap, with the parent
using a comfort hold (as shown in the
figure below) to support the side of the
childs head against the parents chest. This
protects the childs head from sudden
movements that could cause injury, and
hugging the child reduces anxiety and
increases cooperation.