Ear Exam With Otoscope
Introduction
What Is an Otoscopy Examination?
An otoscopy exam allows clinicians to look inside the ear canal and assess the health of the eardrum and middle ear. It’s a quick, safe, and essential part of diagnosing ear infections, hearing concerns, and other ENT conditions.
This guide explains exactly how clinicians perform the procedure so patients feel informed, reassured, and confident.
Begin by washing your hands, explaining the procedure in simple terms, and gaining informed consent.
Equipment
Before examining the ear, ensure:
- The light is switched on
- Rotate the neck clockwise to turn on
- Correct speculum size
- As patients have different size ear canals
- You should use the correct size for a comfortable fit
- Holding the otoscope
- Hold in a pencil position
- Should be inline with the jaw
- And stabilised by your pinky
Proper equipment handling ensures a safe and accurate examination.
| Patient Type | Speculum Size (mm) |
| Infant | 2 |
| Child | 3 – 4 |
| Adult | 4 – 6 |
Inspection
The outer ear is carefully inspected for visible signs of:
- Redness
- Discharge
- Scarring
- Swelling
A full inspection would include the pinna, mastoid, and pre-auricular region. However, this is sufficient, as our main objective is the inner ear.
Always begin with the “good ear”, as this is your reference.
Palpate
Gently palpate around the ear to check for soreness or tenderness, which may signal inflammation or underlying pathology.
Focus on the:
- Pinna
- Tragus
Insertion
A fresh, single‑use speculum is attached to the otoscope and inserted into the outer third of the ear canal.
If a patient has an onset of infection in their “good ear”, remember to change speculums between ears.
1. Straightening the Ear Canal
To improve visibility, gently pull the pinna up and back, straightening the ear canal for a clearer view.
2. Inserting the Otoscope
The otoscope is inserted inline with the jaw, and pointed towards the noise. Use your pinky to stabilise your hand.
3. Viewing the Ear Canal and Eardrum
The speculum is advanced 1 – 2 cm into the ear. Reposition yourself not the otoscope, to prevent discomfort.
- Ear canal
- The canal should be the same colour as the patient’s skin and lined with fine, tiny hairs.
- Ear wax
- Normal cerumen is typically yellow to brown in colour and may appear soft or slightly firm depending on the individual.
- Eardrum (tympanic membrane)
- A healthy eardrum looks white to light grey, is translucent, and should display a clear cone of light reflecting from the otoscope.
The exam stops immediately if the patient experiences pain or discomfort. The speculum is disposed in a yellow clinical waste bin.
Acute Otitis Media
Part of pharmacy first, includes identifying acute otitis media for those between 1 – 17 years old. Acute otitis media is described as red and inflamed ear canal with potential discharge. Alongside the visual colour change, the tympanic membrane bulges, changing reflected lights position from the otoscope.
- Left ear (Normal)
- Light is seen between 7 and 8 o’clock
- Right ear (Normal)
- Light is seen between 4 and 5 o’clock
A change in reflected light would indicate bulging, a sign of build up or inflammation.
Clinical Pathways presents the guidelines required to treat acute otitis media:
Medicines Prep 