Examinations & Procedures - Part 2

Otoscopic Examination

There are many conditions that can be diagnosed or assessed through otoscopic examination. Here are some of the most common conditions and their associated findings:

1. Otitis externa: This is an infection of the outer ear canal. The ear canal may be swollen, red, and tender to touch. There may be pus or discharge in the ear canal. The eardrum is usually normal, but it may appear reddened or have debris on it.

2. Otitis media: This is an infection of the middle ear. The eardrum may appear red, bulging, and opaque. There may be fluid behind the eardrum, which can cause hearing loss. In severe cases, the eardrum may rupture and discharge pus.

3. Eustachian tube dysfunction: This is a condition where the Eustachian tube, which connects the middle ear to the back of the throat, is blocked or not functioning properly. The eardrum may appear retracted or pulled inward, and there may be fluid behind the eardrum.

4. Tympanic membrane perforation: This is a hole in the eardrum. The eardrum may appear torn or have a visible hole. There may be discharge from the ear and hearing loss.

5. Cerumen impaction: This is a buildup of earwax in the ear canal. The ear canal may be blocked by a visible plug of earwax, and the eardrum may not be visible.

6. Foreign body in the ear: This is an object that has been inserted into the ear canal. The object may be visible in the ear canal, and the eardrum may be red or inflamed.

It is important to note that not all conditions can be diagnosed through otoscopic examination alone, and further testing or evaluation may be necessary for an accurate diagnosis.

Steps of otoscopic examination

An otoscope is a medical instrument used to examine the external ear canal and eardrum. Here are the steps to perform an otoscopic examination:

1. Prepare the patient: Ask the patient to sit comfortably with their head tilted slightly towards the opposite shoulder to the ear being examined. Make sure there is adequate lighting in the room to perform the examination.

2. Inspect the external ear: Use a penlight or the otoscope light to inspect the external ear for any abnormalities such as redness, swelling, or discharge.

3. Select an appropriate speculum: Choose a speculum that is appropriate for the size of the patient's ear canal. Lubricate the speculum with a water-soluble gel or mineral oil.

4. Insert the speculum: Hold the otoscope with your dominant hand and gently pull the patient's ear upward and backward with your other hand. Slowly insert the speculum into the ear canal until you see the eardrum.

5. Inspect the eardrum: Use the otoscope light to examine the eardrum. Look for any abnormalities such as perforations, fluid behind the eardrum, or signs of infection.

6. Remove the speculum: Gently remove the speculum from the ear canal.

7. Repeat on the other ear: Repeat the examination on the other ear.

8. Clean the otoscope: After use, clean the otoscope with an alcohol swab to prevent the spread of infection.

It is important to note that otoscopic examination requires practice and patience to master. If you are not confident in performing this procedure, it is recommended to seek guidance from a more experienced practitioner.

Different conditions and their specific findings on otoscopy

There are many conditions that can be diagnosed or assessed through otoscopic examination. Here are some of the most common conditions and their associated findings:

1. Otitis externa: This is an infection of the outer ear canal. The ear canal may be swollen, red, and tender to touch. There may be pus or discharge in the ear canal. The eardrum is usually normal, but it may appear reddened or have debris on it.

2. Otitis media: This is an infection of the middle ear. The eardrum may appear red, bulging, and opaque. There may be fluid behind the eardrum, which can cause hearing loss. In severe cases, the eardrum may rupture and discharge pus.

3. Eustachian tube dysfunction: This is a condition where the Eustachian tube, which connects the middle ear to the back of the throat, is blocked or not functioning properly. The eardrum may appear retracted or pulled inward, and there may be fluid behind the eardrum.

4. Tympanic membrane perforation: This is a hole in the eardrum. The eardrum may appear torn or have a visible hole. There may be discharge from the ear and hearing loss.

5. Cerumen impaction: This is a buildup of earwax in the ear canal. The ear canal may be blocked by a visible plug of earwax, and the eardrum may not be visible.

6. Foreign body in the ear: This is an object that has been inserted into the ear canal. The object may be visible in the ear canal, and the eardrum may be red or inflamed.

It is important to note that not all conditions can be diagnosed through otoscopic examination alone, and further testing or evaluation may be necessary for an accurate diagnosis.

Conditions requiring urgent ENT review

There are several ear problems that should be referred to an ENT (Ear, Nose, and Throat) doctor for urgent review. Here are some of the most common ones:

1. Acute otitis media with severe symptoms: If a patient presents with severe ear pain, high fever, or signs of a more serious infection such as meningitis, they should be urgently referred to an ENT doctor.

2. Tympanic membrane perforation with severe symptoms: If a patient has a perforated eardrum with severe pain, dizziness, or hearing loss, they should be urgently referred to an ENT doctor.

3. Sudden sensorineural hearing loss: If a patient experiences a sudden loss of hearing in one or both ears, they should be urgently referred to an ENT doctor as this can be a sign of a serious condition that requires prompt treatment.

4. Mastoiditis: If a patient has swelling behind the ear, fever, and ear pain, they may have mastoiditis, which is a serious infection of the mastoid bone. Urgent referral to an ENT doctor is necessary in this case.

5. Facial nerve paralysis: If a patient experiences sudden facial weakness or paralysis on one side, this could be a sign of a serious condition such as Bell's palsy or a tumor, and they should be urgently referred to an ENT doctor.

It is important to note that the urgency of referral may vary depending on the severity of symptoms and individual patient factors, and clinical judgement should always be used when deciding whether to urgently refer a patient to an ENT doctor.