An otoscope is a hand-held instrument with a tiny light and a cone-shaped attachment called an ear speculum. It is used to examine the ear canal.

• Inspect the external auditory canal.
   
• Evaluate Tympanic membrane
  
  
  • Note the color (red, white, yellow) and translucency (transparent, opaque) and position (retracted, neutral or bulging) of the drum
     
  • Identify the pars tensa with its cone of light, the handle and short process of malleus, and the anterior and posterior folds of the pars flaccida and position of the malleus handle.
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Air inflation Otoscopy (Pneumatic-otoscope) is very useful to evaluate middle ear disease. Assess the mobility of tympanic membrane by applying positive and negative pressures with the rubber squeeze bulb.

Purpose:
An ear examination is a normal part of most routine physical examinations by a doctor or nurse. It is also done when an ear infection or other type of ear problem is suspected. An otoscope allows the doctor to look into the ear canal to see the ear drum. Redness or fluid in the eardrum can indicate an ear infection. Some otoscopes (called pneumatic otoscopes) can deliver a small puff of air to the eardrum to see if the eardrum will vibrate (which is normal). An ear examination with an otoscope can also detect a build-up of wax in the ear canal or a rupture or puncture of the eardrum.

Description:
An ear examination with an otoscope is usually done by a doctor or a nurse as part of a complete physical examination. The ears may also be examined if an ear infection is suspected due to fever, ear pain, or hearing loss. The child will often be asked to tip the head slightly toward the shoulder opposite of the ear being examined, so the ear to be examined is pointing up. The doctor or nurse may hold the ear lobe as the speculum is inserted into the ear and may adjust the position of the otoscope to get a better view of the ear canal and eardrum. Both ears are usually examined, even if there seems to be a problem with just one ear.

The ear canal is normally skin-colored and is covered with tiny hairs. It is normal for the ear canal to have some yellowish-brown earwax. The eardrum is typically thin, shiny, and pearly-white to light gray in color. The tiny bones in the middle ear can be seen pushing on the eardrum membrane like tent poles. The light from the otoscope will reflect off of the surface of the ear drum.

An ear infection will cause the eardrum to look red and swollen. In cases where the eardrum has ruptured, there may be fluid draining from the middle ear. A doctor may also see scarring, retraction of the eardrum, or bulging of the eardrum.

Precautions:
No precautions are required. However, if an ear infection is present, an ear examination may cause some discomfort or pain. If there is an object lodged in the ear canal, pushing on the otoscope may push the object further into the ear and damage the eardrum.

Preparation:
No preparation is required prior to an ear examination with an otoscope. The ear speculum, which is inserted into the ear, is cleaned and sanitized before it is used. Speculums come in various sizes, and the doctor or nurse selects the size that is most comfortable for the child's ear. Sometimes if there is an excessive build up of wax in the ear, the doctor or nurse will remove some of it so that the eardrum can be seen more clearly.

Aftercare:
If an ear infection is diagnosed, the patient may require treatment with antibiotics. If there is a buildup of wax in the ear canal, it might be rinsed or scraped out.

Risks:
This type of ear examination is simple and generally harmless. Caution should always be used any time an object is inserted into the ear. This process can irritate an infected external ear canal and can rupture an eardrum if performed improperly or if the patient moves suddenly. If an object lodged in the ear is what is causing discomfort, pushing in the otoscope without checking first may result in the object being pushed further into the ear, possibly causing damage to the eardrum or further irritating the ear canal.

Parental Concerns:
An ear exam with an otoscope can occasionally cause some discomfort if there is an ear infection or other ear problem. If a child has frequent ear infections a doctor may recommend getting an otoscope designed for in home use. In this case, the doctor will show the parent how to use it, and the parent is encouraged to practice on healthy adults before attempting to use it on the child.