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Louise Fincher, EdD, ATC, LATLouise Fincher, EdD, ATC, LATAssociate Professor/Program DirectorAssociate Professor/Program Director
The University of Texas at ArlingtonThe University of Texas at Arlington
Use of the Use of the Otoscope in Otoscope in Athletic Athletic TrainingTraining
Objectives
Briefly discuss the types and features of the Briefly discuss the types and features of the otoscopeotoscope
Provide an overview of otoscopic Provide an overview of otoscopic assessment proceduresassessment procedures
Briefly discuss the types and features of the Briefly discuss the types and features of the otoscopeotoscope
Provide an overview of otoscopic Provide an overview of otoscopic assessment proceduresassessment procedures
Types & Features of the OtoscopeTypes & Features of the Otoscope
Types of Otoscopes
Pocket stylePocket style < $50< $50
Pocket stylePocket style < $50< $50
Pocket stylePocket style
Clinical modelClinical model
Clinical modelClinical model $200 - $400+$200 - $400+
Clinical modelClinical model $200 - $400+$200 - $400+
Features of the Otoscope
Power sourcePower source Battery (most common in Battery (most common in
athletic training clinical athletic training clinical setting)setting)
Electric Electric
Power sourcePower source Battery (most common in Battery (most common in
athletic training clinical athletic training clinical setting)setting)
Electric Electric Light sourceLight source
Incandescent bulb (produces a Incandescent bulb (produces a yellow light)yellow light)
Hallogen bulb (Hallogen bulb (bestbest – – produces a white light)produces a white light)
Light sourceLight source Incandescent bulb (produces a Incandescent bulb (produces a
yellow light)yellow light) Hallogen bulb (Hallogen bulb (bestbest – –
produces a white light)produces a white light)
Features of the Otoscope
MagnifierMagnifier Not available on all modelsNot available on all models Provides better view of Provides better view of
tympanic membrane, tympanic membrane, particularly for beginners particularly for beginners
MagnifierMagnifier Not available on all modelsNot available on all models Provides better view of Provides better view of
tympanic membrane, tympanic membrane, particularly for beginners particularly for beginners
Features of the Otoscope
SpeculumSpeculum Variety of sizesVariety of sizes Reusable or disposableReusable or disposable
SpeculumSpeculum Variety of sizesVariety of sizes Reusable or disposableReusable or disposable
Overview of Otoscopic Overview of Otoscopic AssessmentAssessment
Examination of the EarExamination of the Ear
HHistoryistoryOObservationbservationPPalpationalpation
HHistoryistoryOObservationbservationPPalpationalpationSSpecialpecial teststests
Otoscopic assessmentOtoscopic assessment
SSpecialpecial teststests Otoscopic assessmentOtoscopic assessment
Examination of the EarExamination of the Ear
HistoryHistoryHistoryHistory TraumaTrauma Allergies, colds, sinus drainageAllergies, colds, sinus drainage Changes in pressure (flying, diving)Changes in pressure (flying, diving) DizzinessDizziness Changes in hearingChanges in hearing Duration of symptomsDuration of symptoms
TraumaTrauma Allergies, colds, sinus drainageAllergies, colds, sinus drainage Changes in pressure (flying, diving)Changes in pressure (flying, diving) DizzinessDizziness Changes in hearingChanges in hearing Duration of symptomsDuration of symptoms
Examination of the Ear
ObservationObservationObservationObservation RednessRedness SwellingSwelling DrainageDrainage Foreign objectForeign object Cuts, scrapes, Cuts, scrapes,
bruisesbruises
RednessRedness SwellingSwelling DrainageDrainage Foreign objectForeign object Cuts, scrapes, Cuts, scrapes,
bruisesbruises
Examination of the Ear
PalpationPalpationPalpationPalpation Gentle pressure Gentle pressure
on traguson tragus
Gentle pressure Gentle pressure on traguson tragus
Examination of the Ear
PalpationPalpationPalpationPalpation Traction on ear lobe & Traction on ear lobe &
pinnapinna
Traction on ear lobe & Traction on ear lobe & pinnapinna
Otoscopic Assessment
Evaluate the Evaluate the noninvolved ear firstnoninvolved ear first
Evaluate the Evaluate the noninvolved ear firstnoninvolved ear first
This practice provides This practice provides a basis for comparison a basis for comparison ANDAND prevents cross- prevents cross-contaminationcontamination
This practice provides This practice provides a basis for comparison a basis for comparison ANDAND prevents cross- prevents cross-contaminationcontamination
Otoscopic Assessment
Step 1:Step 1:Step 1:Step 1: Place your patient in a Place your patient in a
seated position with seated position with his/her head turned his/her head turned slightly downward and slightly downward and away from the ear to be away from the ear to be examinedexamined
Place your patient in a Place your patient in a seated position with seated position with his/her head turned his/her head turned slightly downward and slightly downward and away from the ear to be away from the ear to be examinedexamined
Otoscopic Assessment
Step 1 (cont.):Step 1 (cont.):Step 1 (cont.):Step 1 (cont.): Think of this as the Think of this as the
“puppy position” “puppy position” (puppies always cock (puppies always cock their heads to the side their heads to the side when you talk to them)when you talk to them)
Think of this as the Think of this as the “puppy position” “puppy position” (puppies always cock (puppies always cock their heads to the side their heads to the side when you talk to them)when you talk to them)
Otoscopic Assessment
Step 2:Step 2:Step 2:Step 2: Select the largest Select the largest
possible speculum possible speculum that can be that can be comfortably inserted comfortably inserted into the earinto the ear
Select the largest Select the largest possible speculum possible speculum that can be that can be comfortably inserted comfortably inserted into the earinto the ear
Otoscopic Assessment
Step 2 (cont.):Step 2 (cont.):Step 2 (cont.):Step 2 (cont.): When inserted, the When inserted, the
speculum should fit speculum should fit snugly in the outer snugly in the outer third of the canal third of the canal and rest against the and rest against the tragustragus and anterior and anterior wall of the canalwall of the canal
When inserted, the When inserted, the speculum should fit speculum should fit snugly in the outer snugly in the outer third of the canal third of the canal and rest against the and rest against the tragustragus and anterior and anterior wall of the canalwall of the canal
Modified from Middle Ear Conditions. Anatomical Chart Co. Skokie, IL, 1999.
Otoscopic Assessment
Step 2 (cont.):Step 2 (cont.):Step 2 (cont.):Step 2 (cont.): Choosing a Choosing a
speculum that is too speculum that is too small will cause small will cause movement within movement within the canal the canal
Excessive Excessive movement can cause movement can cause discomfort for your discomfort for your patientpatient
Choosing a Choosing a speculum that is too speculum that is too small will cause small will cause movement within movement within the canal the canal
Excessive Excessive movement can cause movement can cause discomfort for your discomfort for your patientpatient
Modified from Middle Ear Conditions. Anatomical Chart Co. Skokie, IL, 1999.
Otoscopic Assessment
Step 3:Step 3:Step 3:Step 3: Hold the otoscope Hold the otoscope
with the same hand as with the same hand as the ear you are the ear you are examining examining right ear, right handright ear, right handleft ear, left handleft ear, left hand
Hold the otoscope Hold the otoscope with the same hand as with the same hand as the ear you are the ear you are examining examining right ear, right handright ear, right handleft ear, left handleft ear, left hand
Otoscopic Assessment
Step 3 (cont.):Step 3 (cont.):Step 3 (cont.):Step 3 (cont.): The otoscope should The otoscope should
be stabilized by be stabilized by placing the ring and placing the ring and little finger resting on little finger resting on the patient’s cheek or the patient’s cheek or templetemple
The otoscope should The otoscope should be stabilized by be stabilized by placing the ring and placing the ring and little finger resting on little finger resting on the patient’s cheek or the patient’s cheek or templetemple
Otoscopic Assessment
Pencil GripPencil Grip Hammer GripHammer Grip
Otoscopic Assessment
Step 4:Step 4:Step 4:Step 4: Pull the pinna Pull the pinna
upward and upward and backward to backward to straighten the straighten the canalcanal
Pull the pinna Pull the pinna upward and upward and backward to backward to straighten the straighten the canalcanal
Modified from Middle Ear Conditions. Anatomical Chart Co. Skokie, IL, 1999.
Otoscopic Assessment
Step 5:Step 5:Step 5:Step 5: While maintaining While maintaining
traction on the pinna, traction on the pinna, place the speculum place the speculum of the otoscope of the otoscope at, at, but not inbut not in the ear the ear canalcanal
While maintaining While maintaining traction on the pinna, traction on the pinna, place the speculum place the speculum of the otoscope of the otoscope at, at, but not inbut not in the ear the ear canalcanal
Otoscopic Assessment
Caution:Caution:Caution:Caution: Never insert Never insert
the otoscope the otoscope blindlyblindly
AlwaysAlways“Watch your“Watch your way in” way in”
Never insert Never insert the otoscope the otoscope blindlyblindly
AlwaysAlways“Watch your“Watch your way in” way in”
Otoscopic Assessment
Tip:Tip:Tip:Tip: If the patient If the patient
experiences pain, experiences pain, reposition the reposition the canal by canal by adjusting the adjusting the angle and degree angle and degree of traction on the of traction on the pinnapinna
If the patient If the patient experiences pain, experiences pain, reposition the reposition the canal by canal by adjusting the adjusting the angle and degree angle and degree of traction on the of traction on the pinnapinna
Otoscopic Assessment
Caution:Caution:Caution:Caution: If the patient’s If the patient’s
discomfort persists discomfort persists even after even after readjustment of the readjustment of the canal, halt the canal, halt the examination and examination and refer the patient to a refer the patient to a physician.physician.
If the patient’s If the patient’s discomfort persists discomfort persists even after even after readjustment of the readjustment of the canal, halt the canal, halt the examination and examination and refer the patient to a refer the patient to a physician.physician.
Otoscopic Assessment
Step 6:Step 6:Step 6:Step 6: Once the tympanic Once the tympanic
membrane comes into membrane comes into view, rotate the view, rotate the speculum to view as speculum to view as much of the membrane much of the membrane as possibleas possible
Once the tympanic Once the tympanic membrane comes into membrane comes into view, rotate the view, rotate the speculum to view as speculum to view as much of the membrane much of the membrane as possibleas possible
Posterior superiorPosterior superior Anterior superiorAnterior superior Anterior inferiorAnterior inferior Posterior inferiorPosterior inferior
Posterior superiorPosterior superior Anterior superiorAnterior superior Anterior inferiorAnterior inferior Posterior inferiorPosterior inferior
Marty DR. The Ear Book. Jefferson City, MO: Lang ENT Publishing. 1987;Color plate 1.
Otoscopic Assessment
Like trying to Like trying to view the corners view the corners of a room through of a room through a key holea key hole
Like trying to Like trying to view the corners view the corners of a room through of a room through a key holea key hole
TipTipTipTip
Marty DR. The Ear Book. Jefferson City, MO: Lang ENT Publishing. 1987;Color plate 1.
Modified from Middle Ear Conditions. Anatomical Chart Co. Skokie, IL, 1999.
This is due to the angle of the This is due to the angle of the membrane within the canalmembrane within the canal
Otoscopic Assessment
TipTipTipTip The posterior The posterior
inferior portion of inferior portion of the membrane is the membrane is often difficult to often difficult to seesee
The posterior The posterior inferior portion of inferior portion of the membrane is the membrane is often difficult to often difficult to seesee
Fincher AL. Use of the otoscope in the evaluation of common injuries and illnesses of the ear. J Athl Train. 1994;29:53,54.
Modified from Middle Ear Conditions. Anatomical Chart Co. Skokie, IL, 1999.
Otoscopic Assessment
Step 7:Step 7: Step 7:Step 7:
LR
Inspect the membrane for Inspect the membrane for color, clarity, & position color, clarity, & position Pearly grayPearly graySemitransparentSemitransparentNot bulging or retractedNot bulging or retracted
Inspect the membrane for Inspect the membrane for color, clarity, & position color, clarity, & position Pearly grayPearly graySemitransparentSemitransparentNot bulging or retractedNot bulging or retracted
Fincher AL. Use of the otoscope in the evaluation of common injuries and illnesses of the ear. J Athl Train. 1994;29:53,54.
Otoscopic Assessment
Step 8:Step 8: Identify key landmarksIdentify key landmarks
Step 8:Step 8: Identify key landmarksIdentify key landmarks
LR
UmboUmbo
Short Short processprocessMalleusMalleusMalleusMalleus
• ManubriumManubrium• Short process Short process • UmboUmbo
• ManubriumManubrium• Short process Short process • UmboUmbo
Light reflexLight reflexLight reflexLight reflex
Fincher AL. Use of the otoscope in the evaluation of common injuries and illnesses of the ear. J Athl Train. 1994;29:53,54.
Otoscopic Assessment
Step 8 (cont.):Step 8 (cont.): Identify key landmarksIdentify key landmarks
Step 8 (cont.):Step 8 (cont.): Identify key landmarksIdentify key landmarks
LR
Note that manubrium Note that manubrium angles toward the 10:00 angles toward the 10:00 position in the left ear position in the left ear and the 2:00 position in and the 2:00 position in the right earthe right ear
Note that manubrium Note that manubrium angles toward the 10:00 angles toward the 10:00 position in the left ear position in the left ear and the 2:00 position in and the 2:00 position in the right earthe right ear
Fincher AL. Use of the otoscope in the evaluation of common injuries and illnesses of the ear. J Athl Train. 1994;29:53,54.
Otoscopic Assessment
Step 8 (cont.):Step 8 (cont.): Identify key landmarksIdentify key landmarks
Step 8 (cont.):Step 8 (cont.): Identify key landmarksIdentify key landmarks
LR
Pars tensaPars tensa
Pars flaccidaPars flaccidaPars flaccidaPars flaccidaPars tensaPars tensaPars tensaPars tensaAnnulusAnnulusAnnulusAnnulus
Pars flaccidaPars flaccida
Fincher AL. Use of the otoscope in the evaluation of common injuries and illnesses of the ear. J Athl Train. 1994;29:53,54.
Otoscopic Assessment
Step 8 (cont.):Step 8 (cont.): Step 8 (cont.):Step 8 (cont.): Identify key landmarksIdentify key landmarks
Look beyond the membraneLook beyond the membrane
• StapesStapes
• IncusIncus
Identify key landmarksIdentify key landmarksLook beyond the membraneLook beyond the membrane
• StapesStapes
• IncusIncus
Fincher AL. Use of the otoscope in the evaluation of common injuries and illnesses of the ear. J Athl Train. 1994;29:53.
Otoscopic Assessment
Step 9:Step 9: Look for abnormalitiesLook for abnormalities
FluidFluidPerforationsPerforations
Step 9:Step 9: Look for abnormalitiesLook for abnormalities
FluidFluidPerforationsPerforations
PerforationMarty DR. The Ear Book. Jefferson City, MO: Lang ENT Publishing. 1987;Color plate 8.
Fluid & Air BubblesFincher AL. Use of the otoscope in the evaluation of common injuries andillnesses of the ear. J Athl Train. 1994;29:54.
Otoscopic Assessment
Step 10Step 10Step 10Step 10 Work with your ACI to develop your Work with your ACI to develop your
confidence and skillconfidence and skill
Work with your ACI to develop your Work with your ACI to develop your confidence and skillconfidence and skill
PRACTICE, PRACTICE, PRACTICE !!!PRACTICE, PRACTICE, PRACTICE !!! You must look at many ears to develop to You must look at many ears to develop to
become comfortable with “normal”become comfortable with “normal”
PRACTICE, PRACTICE, PRACTICE !!!PRACTICE, PRACTICE, PRACTICE !!! You must look at many ears to develop to You must look at many ears to develop to
become comfortable with “normal”become comfortable with “normal”
Summary
The 10 step process for otoscopy The 10 step process for otoscopy outlined in this presentation is intended outlined in this presentation is intended to serve as foundation for learning and to serve as foundation for learning and becoming comfortable with using the becoming comfortable with using the otoscope for ear evaluation.otoscope for ear evaluation.
The 10 step process for otoscopy The 10 step process for otoscopy outlined in this presentation is intended outlined in this presentation is intended to serve as foundation for learning and to serve as foundation for learning and becoming comfortable with using the becoming comfortable with using the otoscope for ear evaluation.otoscope for ear evaluation.
Summary
Proficiency requires Proficiency requires PRACTICEPRACTICE, , PRACTICEPRACTICE, & more , & more PRACTICEPRACTICE!!
Proficiency requires Proficiency requires PRACTICEPRACTICE, , PRACTICEPRACTICE, & more , & more PRACTICEPRACTICE!!
What Questions Do You Have?What Questions Do You Have?
Feel free to contact me with further questions:Feel free to contact me with further questions:Lfincher@uta.eduLfincher@uta.edu