Otoscopy Otoscopy • Basics: - Inspect the ear and note any skin abnormalities or discharge - For patients complaining of ear pain or discharge, gently move the auricle up and down and apply pressure to the tragus and the mastoid processes. ✓ Presence of tenderness can indicate inflammation and/or infection. Procedure 1. Place the largest speculum that comfortably fits in the patient's ear on the head of the otoscope and turn on the light source. 2. Angle the otoscope handle either directly downward or towards the patient’s forehead. 3. Place the largest speculum that comfortably fits in the patient's ear on the head of the otoscope and turn on the light source. 4. Place the largest speculum that comfortably fits in the patient's ear on the head of the otoscope and turn on the light source. Interpretation • • • • Inspect for the presence of discharge, redness, cerumen (secretions of the apocrine glands in the external auditory canal), swelling and foreign bodies. The tympanic membrane normally reflects the otoscope’s light, which is know as the light reflex/cone of light. External auditory canal assessment: - Excessive ear wax: most common cause of conductive hearing loss. - Erythema and edema: typically associated with otitis externa. - Discharge: may suggest externa or otitis media with associated tympanic membrane perforation. - Foreign bodies: these may include cotton buds, insects and other small objects. Tympanic membrane assessment: - Colour: should be pearly grey and translucent. Erythema suggests inflammation such as the case with acute otitis media. - - Shape: ✓ Should be flat. ✓ Bulging suggests increased middle ear pressure -> caused by acute otitis media with effusion -> most often an associated visible fluid. ✓ Retraction: reduced middle ear pressure -> caused by pharyngotympanic tube dysfunction secondary to upper respiratory tract infections and allergies. Light reflex: ✓ If healthy: should appear in the anterior inferior quadrant ✓ In the left ear: should be positioned in the 7 o’clock to 8 o’clock. ✓ In the right ear “should be positioned in the 4’ clock to 5 o’clock. ✓ Absence of distortion of the light reflex is associated with otitis media -> due to bulging.