What is the correct size speculum to examine the clients ear?

With any ear exam, you will want the patient to sit down and slightly tilt their head away from you, to obtain easier access to the ear.

Turn on the scope

Turn the scope on at full intensity.

Review your speculum options

Attach a new disposable ear tip or speculum. These come in a variety of styles and sizes; as a rule of thumb, use a 4.25 mm tip for adults/children and 2.5mm for infants. In certain situations, a special Instrumentation Tip can be used for foreign body or cerumen/ear wax removal.

Handling options

There are two common ways to hold the otoscope and it’s all a matter of preference.

Hammer Grip: Some clinicians choose to hold the otoscope like a hammer by gripping the top of the power handle between your thumb and forefinger, close to the light source.

Pencil Grip: For more control, some clinicians choose to hold the otoscope like a pencil, between the thumb and the forefinger, with the ulnar aspect of the hand resting firmly but gently against the patient’s cheek. With this technique, if the patient turns or moves, your steady hand can move with the patient’s head to help prevent injury.

Examine the patient’s good ear

It’s best practice to examine the healthy ear first. This allows you to see the patient’s normal ear anatomy and compare to the other ear, while helping to prevent the spread of infection.

Examine the external canal

Straighten the outer ear canal to make insertion of the speculum easier. For adults, retract the pinna upwards and backwards; for children under three, retract the pinna downwards and backwards.

Steer the scope into the canal as you look until you can see the tympanic membrane or anything that’s in the way.

Adjust the focus

The MacroView focusing wheel is in the default position when the green line, aligns the corresponding green dot on the side of the instrument. This allows you to focus for your own vision if needed using the wheel.

It may be necessary to adjust the position of the otoscope to get a complete view of the entire ear canal and all areas of the tympanic membrane.

Remove the speculum

After the examination, the used disposable speculum should be removed and discarded from the otoscope. Twist the speculum off by hand or rotate the MacroView ‘Tip Grip’ ring counter-clockwise to disengage the speculum.

Pnuematic Otoscopy

Using the insufflator bulb

To help determine if there is fluid behind the drum (a sign of infection), you can use an insufflator bulb to gently puff air at the thin membrane. A lack of movement may be a clue that the ear has fluid, which may not be visible otherwise. Wlech Allyn SofSeal™ tips can help better seal against the canal wall – making it easier to see TM movement of the tympanic membrane.

An otoscope or auriscope is a medical device which is used to look into the ears.[1] Health care providers use otoscopes to screen for illness during regular check-ups and also to investigate ear symptoms. An otoscope potentially gives a view of the ear canal and tympanic membrane or eardrum. Because the eardrum is the border separating the external ear canal from the middle ear, its characteristics can be indicative of various diseases of the middle ear space. The presence of earwax (cerumen), shed skin, pus, canal skin edema, foreign body, and various ear diseases can obscure any view of the eardrum and thus severely compromise the value of otoscopy done with a common otoscope, but confirm the presence of obstructing symptoms.

The most commonly used otoscopes—those used in emergency rooms, pediatric offices, general practice, and by internists- are monocular devices. They provide only a two-dimensional view of the ear canal, its contents, and usually at least a portion of the eardrum, depending on what is within the ear canal and its status. Another method of performing otoscopy (visualization of the ear) is use of a binocular microscope, in conjunction with a larger plastic or metal ear speculum, with the patient supine and the head tilted, which provides a much larger field of view and the added advantages of a stable head, far superior lighting, and most importantly, depth perception. A binocular (two-eyed) view is required in order to judge depth. If wax or another material obstructs the canal and/or a view of the entire eardrum, it can easily and confidently be removed with specialized suction tips and other microscopic ear instruments, whereas the absence of depth perception with the one-eyed view of a common otoscope makes removal of anything more laborious and hazardous. Another major advantage of the binocular microscope is that both of the examiner's hands are free, since the microscope is suspended from a stand. The microscope has up to 40x power magnification, which allows much more detailed viewing of the entire ear canal, and of the entire eardrum unless edema of the canal skin prevents it. Subtle changes in the anatomy are much more easily detected and interpreted than with a monocular view otoscope. Traditionally only ENT specialists (otolaryngologists) and otologists (subspecialty ear doctors) acquire binocular microscopes and the necessary skills and training to use them, and incorporate their routine use in evaluating patient's ear complaints. Studies have shown that reliance on a monocular otoscope to diagnose ear disease results in a more than 50% chance of misdiagnosis, as compared to binocular microscopic otoscopy. The expense of acquiring a binocular microscope is only one obstacle to its being more widely adapted to general medicine. The low level of familiarity with binocular otoscopy among pediatric and general medicine professors in physician training programs is probably a more difficult obstacle to overcome. Thus, the standard of general otologic diagnosis and ear care remains, for the most part, the largely antiquated monocular otoscope.

What is a speculum for the ear?

What instrument is used to examine the ears?

When examining the ear of a patient under the age of 3 the pinna should be pulled?