8/4/2023 0 Comments External auditory canal![]() ![]() The provider should also observe tympanic membrane landmarks, including the pars flaccida on the superior aspect of the tympanic membrane, the pars tensa on the posterior aspect, the light reflex on the inferior and anterior aspect, and the handle of the malleus on the anterior aspect. The provider should evaluate the health of the tympanic membrane and observe factors such as color, presence of perforation, and a bulging appearance. The provider should then slowly progress the speculum into the canal until the tympanic membrane becomes visible. The provider should inspect the health of the external auditory canal and evaluate factors such as the presence of inflammation, discharge, cerumen, and infection. ![]() Next, the provider can gently insert the speculum into the patient’s external auditory canal. In an adult, the examiner should pull the pinna posteriorly and superiorly. In a child, the examiner should pull the pinna posteriorly and inferiorly. This step will facilitate visualization of the tympanic membrane. With the hand that is not holding the otoscope, the provider should grasp and gently pull the patient’s pinna to help straighten the patient’s external auditory canal. The provider should place their free fifth finger of the hand, holding the otoscope against the patient’s cheek to support and brace the hand during the examination. The otoscope is usually held in the right hand when evaluating the patient’s right ear and the left hand when assessing the patient’s left ear. However, it is generally advisable to hold the otoscope like a pen in between the first and second fingers. Providers may have their own preferences regarding how to grasp the otoscope. The provider should select the largest speculum that the patient’s external auditory canal can accommodate, as this will provide maximum lighting for optimal visualization of the ear anatomy. There are often multiple speculum sizes for attachment to the otoscope. Next, the provider can begin the otoscopic exam. Following the evaluation of the facial nerve, the provider can visually examine the health of the external ear, the pinna, noting signs such as wounds, scars, and inflammation. The facial nerve travels through the middle ear and can be affected by ear pathologies such as acute otitis media. Successful completion of these movements demonstrates the integrity of cranial nerve VII, the facial nerve. īefore beginning the otoscopic examination, the provider can ask the patient to demonstrate the strength of their facial muscles by smiling, frowning, elevating the eyebrows, closing the eyes and keeping the eyes closed against resistance, and puffing out the cheeks. For example, untreated acute otitis media can advance to feared complications such as mastoiditis, brain abscesses, or meningitis. Delayed diagnosis of various pathologies of the ear can facilitate progression to more serious conditions, highlighting the importance of otoscopy. Examination of the tympanic membrane and middle ear by otoscopic examination can help providers diagnose a wide variety of conditions, including acute otitis media, traumatic perforation of the tympanic membrane, and cholesteatoma. ![]()
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