Professional Otoscope Auroscope with accessories from Sigma Lance

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By toggling through the light settings a blue light will come on which can highlight fluorescein staining of abrasions and ulcers. Confirm the patient can hear the sound of the tuning fork and then ask them to tell you when they can no longer hear it. Systematically inspect the four quadrants of the tympanic membrane (TM) to avoid missing pathology. Colour Select the light you require (e.g. varying levels of white light or blue light) using the grey switch and hold it close to your eye. Tympanosclerosis often develops secondary to otitis media or after the insertion of a tympanostomy tube. Final steps

Otoscopes are also frequently used for examining patients' noses (avoiding the need for a separate nasal speculum) and (with the speculum removed) upper throats. Absence or distortion of the light reflex is associated with otitis media (due to bulging of the TM). Perforation Components of an otoscope Anatomy of the human ear Right tympanic membrane as seen through a speculum A doctor performs an otoscopy examination The appearance of the eardrum in acute otitis media is dependent on the time that the infection has been present. Typically, the eardrum becomes red or yellow in appearance and is opaque with indistinct landmarks – it can appear to be bulging towards the viewer. Insufflation may show decreased mobility. The otoscope should be held in your right hand for the patient’s right ear and vice versa for the left ear.Scarring of the TM is known as tympanosclerosis and can result in significant conductive hearing loss if it is extensive. Ensure the light is working on the otoscope and apply a sterile speculum (the largest that will comfortably fit in the external auditory meatus). Advance the otoscope under direct vision. Be gentle with the otoscope and ensure movements are slow and considered otherwise you will cause discomfort. External auditory canal assessment Bulging of the TM suggests increased middle ear pressure, which is commonly caused by acute otitis media with effusion (there is often an associated visible fluid level). Robustness, high precision and reliability are essential features that should be taken into account when buying an otoscope. But criteria such as light focus, level of detail and authentic colour rendering are decisive too.

Move in close to the patient’s eye. At around 6cms you will see a magnified view of the eyelids and front of the eye. Skin lesions: look for evidence of pre-malignant (actinic keratoses) and malignant (e.g. basal cell carcinoma, squamous cell carcinoma) skin changes.Repeat your assessment on the other ear, comparing your findings. If the patient has an infection in one ear, you should change the speculum on the otoscope before examining the other ear. Retraction of the TM suggests reduced middle ear pressure, which is commonly caused by pharyngotympanic tube dysfunction secondary to upper respiratory tract infections and allergies. Light reflex Mask the ear not being tested by rubbing the tragus. Do not place your arm across the face of the patient when rubbing the tragus, it is far nicer to occlude the ear from behind the head. If possible shield the patient’s eyes to prevent any visual stimulus.