Otoscopy

Otoscopy (from Greek οὖς, “ear”, and σκοπέω, “to examine”) is a core physical examination technique in ENT practice. It involves visual inspection of the external auditory canal and the tympanic membrane. The procedure is noninvasive, quick, and highly informative. In routine clinical care, it is widely regarded as the diagnostic “gold standard” for many disorders of the external and middle ear.

Otoscopy is performed using an otoscope. In some settings, it can also be done with an ear speculum and a headlight (or head mirror) as the light source. It is a routine examination not only for ENT specialists, but also for pediatricians, internists, and general practitioners.

Equipment and Technique

A standard otoscope consists of a handle with a power source, an illuminated head with a magnifying lens, and interchangeable ear specula. The speculum size is chosen to fit the patient’s ear canal.

The technique typically includes the following steps:

1. Straightening the ear canal: to improve visualization of the tympanic membrane, the pinna is gently pulled. In adults, it is pulled upward and backward. In young children, it is pulled downward and backward.
2. Speculum insertion: the speculum is inserted carefully into the cartilaginous portion of the external auditory canal.
3. Examination: the canal skin and lumen are examined first. The tympanic membrane is then assessed, including its key landmarks.

A more detailed examination may be performed using otomicroscopy (microscopic otoscopy) with an operating microscope, which provides higher magnification and better illumination.

Diagnostic Significance

Otoscopy helps assess several key features that guide diagnosis.

Structures and findings assessed:

• External auditory canal:
  • Patency: patent, narrowed, or occluded.
  • Contents: cerumen, purulent discharge, blood, foreign bodies, or fungal debris.
  • Canal skin: color (normal or erythematous), edema, eczematous changes, or masses.
• Tympanic membrane:
  • Color: normally pearly gray. Erythema suggests inflammation, while a bluish hue can suggest a middle-ear effusion.
  • Position: normal, retracted (commonly with Eustachian tube dysfunction), or bulging (for example, in acute otitis media with pus under pressure).
  • Landmarks: visibility of the malleus handle and the cone of light. Blurring or loss of these landmarks suggests pathology.
  • Integrity: presence or absence of perforation.

Clinical Role

Otoscopy is central to diagnosing common conditions such as acute and chronic otitis media, otitis externa, otitis media with effusion, cerumen impaction, ear foreign bodies, and traumatic tympanic membrane injury. Findings on otoscopy also guide further management. Treatment may include antibiotics or eardrops. If needed, the ear canal can be cleaned and suctioned to remove debris or discharge, and procedures such as myringotomy may be performed. Additional evaluation may also be recommended, for example audiometry or CT.