• Examination of the tympanic membranes and ear
canals is part of routine health maintenance.
• Tympanic membranes should also be visualized with complaint of
ear pain, upper respiratory tract infection, or fever.
• Serial examinations are indicated over several months to check
for resolution of effusion.
• A complaint of hearing loss should also prompt a careful otoscopic
• In the presence of otitis externa, the tympanic
membrane will be difficult to visualize because of occlusion with pus.
• Presence of cerumen in the canal may require removal with a curette
or irrigation in the office or alternatively use of a cerumen-reducing
agent at home with return for reexamination in a few days.
• While most offices have disposable tips for the
otoscope, use of the tips supplied by the manufacturer tend to have
a better fit and yield more accurate results on pneumatic otoscopy.
• A 10-mL syringe with a cut-off angiocatheter plastic tip is useful
for instillation of dilute hydrogen peroxide when irrigation is
• Patient must be still for an adequate examination,
including visualization of the tympanic membrane and insufflation.
• There are 2 positioning alternatives for children who need to
• The clinician should hold the head steady with 1 hand and also
pull the pinna cephalad and posterior with that same hand; the other
hand is holding the otoscope and insufflator.
Tympanic membrane landmarks.
• Using an otoscope, examine the ear canal and
remove any occluding cerumen.
• Choose the appropriately sized ear tip for the patient’s
ear canal and affix it to the otoscope.
• Grasp the helix and pull up and back gently to straighten the
• Insert the speculum tip into the entrance of the ear canal to
visualize the tympanic membrane.
• An airtight seal will need to be obtained when performing pneumatic
• To insufflate, squeeze the bulb to deliver positive pressure
against the tympanic membrane while observing for mobility. Also
observe for movement when releasing the bulb and generating ...
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