Otoscopic examination by J Stankiewicz, MD

J Stankiewicz, MD
Loyola University Medical Education Network

 

The otoscopic exam is performed by gently pulling the auricle upward and backward. In children, the auricle should be pulled downward and backward. This process will move the acoustic meatus in line with the canal. Hold the otoscope like a pen/pencil and use the little finger area as a fulcrum. This prevents injury should the patient turn suddenly.

• 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..

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.

Normal:

• Auditory canal: Some hair, often with yellow to brown cerumen.
• Ear drum:
  • Pinkish gray in color , translucent and in neutral position. 
  • Malleus lies in oblique position behind the upper part of drum.
  • Mobile with air inflation.