Introduction
Approach the examination in a systematic way, starting from the outer parts of the ear before moving to the inner parts of the ear; be prepared to be instructed to move on quickly to certain sections by any examiner. Show
Pinna and Post Auricular AreaInspect the pinna and the mastoid:
Palpate the lymph nodes and pinna, specifically:
 Figure 1 – A basal cell carcinoma located on the posterior aspect of the outer ear External Ear CanalInspect the outer aspect of the external ear canal using the otoscope as a light source Gently straighten out the ear canal by pulling the external ear superiorly and posteriorly Look for signs of:
Tympanic MembraneHold the otoscope like a pen between thumb and index finger, left hand for left ear and right hand for right ear, resting your little finger on the patient’s cheek – this acts as a pivot. Gently straighten out the ear canal by pulling the external ear superiorly and posteriorly For a normal tympanic membrane, you should be able to observe*:
*The cone of light can be used to orientate; it is located in the 5 o’clock position when viewing a normal right tympanic membrane and in the 7 o’clock position for a normal left tympanic membrane. Adapted from work by Michael Hawke MD [CC BY 4.0], via Wikimedia Commons Figure 2 – A normal right tympanic membrane For an abnormal tympanic membrane, common signs may include:
Ensure to check the function of the facial nerve By Michael Hawke MD / CC BY (https://creativecommons.org/licenses/by/4.0) Figure 3 – A traumatic perforation of the left tympanic membrane Assessment of HearingRinne TestStrike the tuning fork (512Hz) against your elbow and place against the mastoid process (bone conduction), then once patient stops hearing it, hold it near the external ear canal (air conduction)
Weber TestStrike the tuning fork (512Hz) against your elbow and place on the patient’s forehead in the midline. Ask the patient whether the sound is heard in the midline or has lateralised
Completing the ExaminationRemember, if you have forgotten something important, you can go back and complete this. To finish the examination, stand back from the patient and state to the examiner that to complete your examination, you would like to perform a:
When assessing a child's ear you pull the pinna in what direction?In adults this is achieved by using the free hand to gently lift the pinna upward and backward. In children, the canal is straightened by pulling the pinna horizontally backward (Figure 2, 3). It is essential to keep the canal straight throughout the examination as this keeps the tympanic membrane in view.
When performing Otoscopy for children aged 3 or less why does the auricle need to be pulled downward and backward?Method Of Exam
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.
What method should be used to inspect the middle ear of a 2 year old patient?Tympanometry. Tympanometry (tim-peh-NOM-eh-tree) shows how well the eardrum moves and can help find middle ear problems, such as fluid behind the eardrum or a perforated eardrum. During this test, the audiologist puts a tympanometer (tim-peh-NOM-eh-tur) probe with a small, rubber tip in the child's ear.
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When examining the ear of a patient under the age of 3 the pinna should be pulled?
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