{"id":2969,"date":"2024-08-13T09:42:24","date_gmt":"2024-08-13T13:42:24","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/?post_type=chapter&p=2969"},"modified":"2025-01-03T15:03:23","modified_gmt":"2025-01-03T20:03:23","slug":"otoscopic-examination","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/otoscopic-examination\/","title":{"raw":"Otoscopic Examination","rendered":"Otoscopic Examination"},"content":{"raw":"You will use an otoscope<\/strong> (see Figure 16)<\/strong> to conduct the otoscopic examination. This medical instrument has a pointed end that fits just inside the opening of the ear and provides illuminated magnification<\/strong> so that you can view the external ear canal and tympanic membrane.<\/span>\r\n\r\n\"\"\r\n\r\nFigure 16:<\/strong> Otoscope.<\/span>\r\n\r\n(By Rouibi Dhia Eddine Nadjm - Own work<\/span>,<\/span> https:\/\/commons.wikimedia.org\/w\/index.php?curid=120072656<\/a> This file is licensed under the<\/span> Creative Commons<\/a> Attribution-Share Alike 4.0 International<\/a> license.)<\/span>\r\n\r\nIf the client\u2019s ear is obstructed with earwax<\/strong>, you might be unable to visualize the tympanic membrane. If so, begin by cleaning the ear.<\/strong> The best way to do this is to place 2 to 3 drops of a warm mineral oil solution into the ear (or use 1 part hydrogen peroxide, 1 part warm water) (American Academy of Otolaryngology-Head and Neck Surgery Foundation, 2024). With the client lying on their side with the affected ear up, leave the solution in for at least 15 minutes to both soften and loosen the earwax. Next, you can use a bulb syringe with warm water to gently flush the ear over a basin or sink. Consult a physician or nurse practitioner first if the client has had ear surgery, ear infections, or perforation of the tympanic membrane (Berg, 2023).<\/span>\r\n\r\nSteps for the otoscopic examination<\/strong> include (see this video for an example of an\u00a0otoscopic examination<\/a>):<\/span>\r\n
    \r\n \t
  1. Have the client sit on the examination table or in a high Fowler\u2019s position. A young child may sit on a parent\u2019s lap or in a supine position with their head turned away from you so that they are stabilized and still.<\/span><\/li>\r\n \t
  2. Place a speculum cover on the otoscope and turn the otoscope light on.<\/span><\/li>\r\n \t
  3. Using the hand of the same side as the ear you are inspecting (e.g., right ear, right hand), grasp the handle close to the otoscope head gently between your thumb, index finger, and middle finger (similar to how you would hold a pen).<\/span><\/li>\r\n \t
  4. Ask the client to slightly tilt their head away from you and keep their head still in this position while using your opposite hand to pull the helix up and back to straighten the external canal so that you can better visualize the tympanic membrane. If the client is under 3 years of age, pull the earlobe down and slightly back instead.<\/span><\/li>\r\n \t
  5. Gently<\/strong> insert the speculum tip<\/strong> just inside the external auditory meatus. Do NOT force the speculum tip in.<\/strong> Do NOT push the whole speculum in \u2013 only the tip.<\/strong><\/span><\/li>\r\n \t
  6. To stabilize the otoscope and ensure the speculum doesn\u2019t move, you can rest the back of your hand (the one holding the otoscope) on the client\u2019s cheek. Some healthcare professionals gently rest the speculum tip on the back of the tragus to stabilize it, which can be helpful. Otherwise, ensure the speculum touches no other parts of the ear: this can damage the ear canal and can also be very painful if the client has an ear infection.<\/span><\/li>\r\n \t
  7. Look through the lens and inspect the canal for any signs of inflammation (erythema, swelling), discharge, and foreign bodies (e.g., toys, beads, pebbles, cotton from a cotton swab, or bugs such as spiders, bed bugs, flies, or earwigs). Describe the colour and quantity of earwax.<\/span><\/li>\r\n \t
  8. Continue looking through the lens to inspect the tympanic membrane for colour, contour, discharge, and integrity.<\/span>\r\n