2-Clinical examination of the ear

2-Clinical examination of the ear
The examination of the ear includes close inspection of the pinna, the external auditory canal and the eardrum. Make sure you gently tilt the pinna forward and look behind the ear. Look for scars from any previous surgery – they may be long healed and are easily missed.
Examine the ear with an auriscope or ‘otoscope’. A good otoscope is expensive but a worthwhile investment. There may be an attachment which permits insufflation of air into the ear canal so that the mobility of the drum can be assessed – pneumatic otoscopy. Modern auriscopes have distal illumination via a fibreoptic cone giving a bright, even light. The battery should be in good condition to give a white light.
A common error in examination of the ear is to use too small a speculum; it is a mistake to think this is gentler – use the largest speculum that can be easily inserted (Fig. 2.1). Important points in the examination of the ear are listed in Box 2.1.