An otoscope is an instrument used for examining the eardrum (tympanic membrane) and ear canal. The instrument has a light source and magnifying system at one end that help better examine the ear structures. The examination of the ear using an otoscope is called otoscopy. Besides examining the ear, the otoscope can also be used for examining the inside of the nose. The first description of otoscopes dates back to the 14th century when the French physician and surgeon Guy de Chauliac proposed a tool that could help diagnose patients reporting ear or nose pain. Modern otoscopes started appearing in the 19th century. An otoscope using air pressure, called a pneumatic otoscope, was invented in Germany in 1864.
Otoscopy may be done as a part of routine medical examination or when you have symptoms such as:
- Ear pain
- Discharge or bleeding from the ear
- Hearing problems
- Fullness in the ear
- Ringing in the ear
- History of foreign body insertion in the ear
Modern-day otoscopes are lighter and sleeker than their predecessors. An otoscope consists of two main parts: a head and handle. It helps examine the external auditory canal (EAC), tympanic membrane (eardrum), and middle ear. The ear is divided into the inner, middle, and external ear. The external ear has a passage called the external auditory canal, which is separated from the middle ear by the eardrum. The otoscope also has magnifying lens that enhances the clinician’s view. The head of the otoscope may be of either of the two types:
- Diagnostic head: As the name suggests, a diagnostic head is fixed to the otoscope and is used for examining the ear. It does not allow the use of micro-instruments through the scope.
- Working (or operating) head: This head carries a magnifying lens that can slide to the side. It enables the passage of micro-instruments through the speculum into the EAC and middle ear for performing procedures such as foreign body or wax removal.
An attachment for applying air pressure called the pneumatic attachment can be connected to the diagnostic head. It allows the assessment of tympanic membrane motion by generating positive pressure in the external auditory canal. The increase in pressure deflects the eardrum inward (medially). On releasing the pressure, the eardrum expands outward (laterally). Pneumatic otoscopy is important for diagnosing fluid certain conditions such as:
- Middle ear effusions (collection of fluid in the middle ear)
- Vascular lesions
- Inner ear fistulas (abnormal connection between the inner ear and middle ear)
You do not need to do any special preparation for an otoscopy. During the procedure:
- The provider may dim the lights in the room.
- A young child is generally asked to lie on their back with their head turned to the side. Alternatively, the child's head may rest against an adult's chest.
- Adults and older children may sit with their heads tilted toward the shoulder opposite the ear being examined.
- The provider will gently pull the pinna or auricle upward and backward (just backward in case of a child) to straighten the ear canal and visualizing the eardrum.
- They may remove any debris or ear wax to allow an adequate examination.
- They will then gently place the tip of the otoscope into your ear.
- A light beam then shines through the otoscope into the ear canal.
- The scope is gently moved in different directions to examine the inside of the ear and eardrum.
- A binocular microscope may sometimes be used to get a magnified view of the structures in the ear.
- Air pressure may be applied through the bulb of the pneumatic attachment to see the movement of the eardrum.
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