This post is going to describe how to perform an otoscopic examination of a patient, from start to finish. I’ll direct it from an audiologist’s point of view, but I am still an audiology student, and hence haven’t acquired a heap of experience yet. This is what is involved.
First up, you need to describe to the patient what you’re going to do. You don’t need to say anything in too much detail, it could just be ‘I’m just going to take a quick look in your ears, so just hold still for me’. For younger kids you can say ‘I’m going to see if I can see the inside of your ear!’ And for really young kids, you might want to get them sitting on the parents lap so just instruct the parents on how to hold them. For wriggly kids, get them sitting across the lap, get the parent to anchor the child’s head to their chest, and restrain the arms with their other hand, just so the child won’t be moving about whilst you’re inside their ear.
Next you need to disinfect your hands with an anti-bacterial gel, before getting your otoscope ready. Double check that the batteries are working and the light is showing. When choosing the speculum tip, you may want to think about using the paediatric one (longer and thinner), if the child is less than about 3 years old, but it really depends on the size of the canal. Otherwise, use an adult one of an appropriate size.
The grip of the otoscope is like a pencil. It is best to switch hands as you change ears. The otoscope will lie horizontally, with the pinky finger straightened, anchored against the patient’s cheek, so as not to make any large movements and damage the inside of the canal, as well as cause discomfort. The other hand (right hand, if examining the left ear), will be holding the top of the pinna (external ear), pulling it up and backwards. This has the goal of straightening the ear canal. We know that the anatomy of the ear canal is to run posteriorly and upwards in the external section, then anteriorly and downwards. By pulling the pinna up and back, the ear canal straightens. In an infant, the pinna needs to be pulled down and back.
Next step is to actually look inside the ear. The idea of doing using the otoscope is to see if there are any pathologies present in the ear, which could be a contraindication towards doing audiological testing, or that there is no occlusion in the ear canal from objects, wax or otherwise. Following is a picture of a normal tympanic membrane with all the major features labelled.
All ears are very different and so you might not be able to see all of these features, but you should be able to tell if you are looking at the tympanic membrane or not, and hopefully if there is fluid in the middle ear space, indicating infection and so on. Once we have learnt a bit more about pathologies of the ear, and signs of them that can be seen using the otoscope, I will write an update!
Once you are finished, carefully remove the otoscope from the ear, and dispose of the speculum tip appropriately and perform correct hand hygiene procedures.
I didn’t put many pictures in of what you might be seeing, but comment if you would like to see some more images of inside an ear canal!