Otoscope Exam

Aka: Otoscope Exam, Otoscopy, Pneumatic Otoscopy, Tympanic Membrane exam

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II. Preparation

  1. Adequate viewing requires >100 foot candles light
  2. Change otoscope bulbs periodically (after 20 hours of use)
  3. Use the largest ear speculum that will fit to give maximal visualization and optimal seal (2 and 4 mm sizes are common)

III. Technique: Observation

  1. Assessment of canal
    1. Otitis Externa
  2. Assessment of Tympanic Membrane
    1. Color and Appearance
      1. Yellow (amber) serous fluid behind TM
        1. Suggests Serous Otitis Media
        2. Air bubbles may also be seen in serous otitis
      2. Marked erythema may suggest Acute Otitis Media
        1. Fever and crying can also bring this on
      3. Landmarks obscured
        1. Suggests Acute Otitis Media
    2. Position
      1. Bulging TM suggests Acute Otitis Media
      2. Retracted TM suggests Eustachian Tube Dysfunction
    3. Mobility
      1. Immobile TM suggests effusion

IV. Technique: Air insufflation (Pneumatic Otoscopy)

  1. Requires airtight seal (Rubber tipped specula)
  2. Avoid excessive pneumatic pressure
  3. Bulb used to blow air against Tympanic Membrane
  4. May also blow air into IV extension tubing
    1. Male end fitting into side of Otoscope
    2. Female end of tube in mouth
      1. Suck on tubing
      2. Blowing into tube fogs lens

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