Examination of the ear
Before any examination we should follow the following steps
Greetings -1
introduce yourself to the patient-2
take the permission from the patient to examine him or her -3
ask the patient which is the better hearing ear -4
always begins examination with better ear and never touch -5
the patient before asking if there is any tenderness
The ear should be examined with either reflected light from a
head mirror or an electric powered head light
When using a head mirror, position the to one side of an
electric lamp with the light source slightly above the level of
the ear. The patient should be seated sideways to the surgeon
who sits opposite the ear to be examined and reflects light on
.to it
The auricle
inspection -1
Examine the auricle in front an behind for signs of inflammation
or skin lesions. The mastoid process should be carefully
examined for scars, redness or tenderness. Be particularly
careful not to miss a fading postauricular or endaural scar. Note
any discharge from the external auditory meatus as well as any
.inflammation of the skin
Also in inspection describe if there is any congenital lesions of
the pinna, cauliflower ear which is adeformity of the pinna as
result of auricular haematoma with supervene
infection ,perichonderitis and surgical scars
palpation -2
palpate the auricle preauricular area postauriclular area for any
lymphnodes, mass, tenderness move the auricle upward and
downward and press on tragus this will cause tenderness in
case of otitis externa tenderness over mastoid bone may
indicate acute mastoiditis. If there is mass do complete
.…examination for mass as site, size, surface
The external auditory meatus
To examine the external auditory canal, pull the auricle
upwards, outwards and backward. In infant, owing to non-
development of the bony external meatus, the auricle has to be
drawn downwards and backwards. Introduce aural speculum
just past the hairs of the outer canal, but avoid contact with
sensitive bony part of the canal. By using aural speculum we
can examine the meatus and remove ane pus or wax before the
using other tools for examination like otoscope. After we
cleaning the external auditory meatus and the first glimpse of
tympanic membrane appeared we can now use otosope for
more details examination of tympanic membrane because of
magnification or using microscope which give more
magnification and permits to do manipulation like palpation for
any mass by using probe through the aural speculum or more
cleaning to the meatus or even middle ear if there is tympanic
membrane perforation. Common examination of meatus also
.include canal stenosis and exostoses
The tympanic membrane
As we mentioned above the examination of tympanic mem.
Needs magnifications for better and more detailed examination
so we used either otosope or for more magnification
.microscope
Features of normal tympanic membrane
color:- the tympanic mem,color pearly gray. The importance -1
of color that any change in color indicates an abnormal
,conditions like
a- red color usually indicates inflammation due to infection,
allergy, irritation by chemical materials
b-yellow color (amber) seen in case with otitis media with
effusion
c-blue color in case of haemotympanum,high jugular bulb,otitis
media with effusion
transperancy :- tympanic mem. Semitransparent -2
a- increase transperany seen in case of healed perforation,
atelectasis
b-decrease transperancy seen in case of adhesive otitis
media,tympanosclerosis, otitis media with effusion, fibrosis of
tym,mem due to recurrent infection,granular myringitis
position-3
.Normal position of tym.mem
a- make an angle with external auditory meatus 55 degree
b-facing anteroinferiory
c-concave toward the external auditory meatus and convex
toward middle ear
this citeria of position make cone of light appears
anteroinferiorly
the change in position indicate abnormal conditions like bulging
which indicates pus accumulation behind tym.mem. or mass
or retraction inward pulling of tym.mem. towards middle ear as
in case of eustachin tube dysfunction
in case of retracted tym.mem. the following changes occur in
.tym.mem
a-the handle of malleus retracted posteriorly so it is appears
shorter
b-dilated blood vessels on perphey of tym.mem. and handle of
malieus
c-prominent lateral process of maiieus
d-abcence cone of light or dearrangement of light
land marks:- we should examine all quadrant of -4
tym.mem.the tym.mem cosist of pars tensa which is the maigor
part and cosist of 3 layers and pars flaccid superiorly consist of
2 layer.the important land marks are handle of malleus which is
retracted slightly post. Cone of light anteoinferiorly, lat. Process
of malleus , long process of incus frequently seen parallel and
behind the handle of malleus and it is sometimes possible to
observe it articulate with head of the stapes.it is important to
knows the land marks and how to draw the right and left
.tym.mem. and illustrate the land marks on drawing
integrity:- the tym.mem. should be intact if there is -5
perforation we should describe it is site, size types(central,
marginal, attic). If there is a perforation make sure what you
can see looking through it lik promontory, incudostapedial
.joint,round window, Eustachian tube orfice, facial canal
The marginal and central perforation occur in pars tensa but
the diferrence between the 2 perforation ,the marginal involves
the annulus(the fibrocartilagenous rim of tym.mem.) and cental
.not involves annulus.Attic perforation occur in pars flaccid
mobility :-the tym.mem. mobile and test of mobility either by -6
asking the patient to do valsalva maneuver or by using
pneumatic Siegle speculum. The immobile tym.mem.occur due
to otitis media with effusion, tympanosclerosis, adhesive otitis
media, atelectasis. Increase mobility may occur in case of
.patulous Eustachian tube
Central perforation
Marginal perforation
ATTIC PERFORATION
Otitis media with effusion
Siegle speculum
high jugular bulb
Haemotympanum
Other examination
It is important to perform fistula test by pressure on the tragus
repeatedly or by using pneumatic siegle speculum look to
nystagmus which occur toward the diseased ear and asks the
patient about feeling of dizziness or vertigo
It is also important to examine the post, nasal space for any
lesion that obstruct Eustachian tube. And examine the cranial
nerves especially concentrate on the examination of facial
nerve. Also examine the neck for lymph nodes especially in
.case of malignancy suspicion
