The Otoscopic Examination

Techniques of Examination:

1. Inspect each auricle and surrounding tissues for deformities, lumps, or skin lesions. Movement of the

auricle (tug test) is painful in acute otitis externa but not in otitis media.

2. Make sure to choose the correct speculum size by selecting the largest one that will still be comfortable

for your patient and place speculum on otoscope.

3. Hold the otoscope in your dominant hand and use your other hand to pull the pinna upward, backward,

and slightly away from the head to straighten out the path of the ear canal.

4. An alternate technique for holding the otoscope is between your thumb and index finger and resting the

ulnar side of your hand on the patient’s cheek so that if they move quickly, your hand and otoscope will

also move with their unexpected movements.

5. Insert speculum gently into ear canal, directing it down and forward. Inspect ear canal as you advance,

looking for discharge, redness, foreign bodies, or swelling.

6. As the tympanic membrane comes into view, note its color, transparency, integrity, position, and

landmarks. Pivot the speculum and adjust your line of sight to visualize the entire membrane.

7. The normal tympanic membrane should appear translucent and pearly gray. Visualize landmarks

including the cone of light, umbo, handle of the malleus, pars tensa, and pars flaccida. Look for

retraction, perforation, and evaluate mobility of membrane using pneumatic otoscopy.

Recognizing Acute Otitis Media

Pneumatic otoscopy is recommended as the primary diagnostic method in the American Academy of

Pediatrics (AAP), American Academy of Family Physicians (AAFP), and American Academy of

Otolaryngology-Head and Neck Surgery (AAOHNS) clinical practice guideline for otitis media with

effusion in young children.

References

1. American Academy of Pediatrics. http://www.aap.org/otitismedia/www/vc/ear/rvw/rvw2.cfm

2. Otoscopic Exam. http://www.kcom.edu/faculty/chamberlain/Website/Sparks/Physical/Oto.htm

3. Bickley, Lynn S. Bates Guide to Physical Examination and History Taking. Lippincott Williams &

Wilkins, 2003.

4. Virtual Pediatric Hospital. http://www.virtualpediatrichospital.org/providers/VirtualPedsPatients/

Case01/Captions/OMDDAOM.shtml

5. American Academy of Family Physicians; American Academy of Otolaryngology-Head and Neck

Surgery; American Academy of Pediatrics Subcommittee on Otitis Media With Effusion. Pediatrics

2004 May;113(5):1412-29.

Category: ENT Notes