Position the patient
With any ear exam, you will want the patient to sit down and slightly tilt their head away from you, to obtain easier access to the ear.
Turn on the scope
Turn the scope on at full intensity.
Review your speculum options
Attach a new disposable ear tip or speculum. These come in a variety of styles and sizes; as a rule of thumb, use a 4.25 mm tip for adults/children and 2.5mm for infants. In certain situations, a special Instrumentation Tip can be used for foreign body or cerumen/ear wax removal.
There are two common ways to hold the otoscope and it’s all a matter of preference.
Hammer Grip: Some clinicians choose to hold the otoscope like a hammer by gripping the top of the power handle between your thumb and forefinger, close to the light source.
Pencil Grip: For more control, some clinicians choose to hold the otoscope like a pencil, between the thumb and the forefinger, with the ulnar aspect of the hand resting firmly but gently against the patient’s cheek. With this technique, if the patient turns or moves, your steady hand can move with the patient’s head to help prevent injury.
Examine the patient’s good ear
It’s best practice to examine the healthy ear first. This allows you to see the patient’s normal ear anatomy and compare to the other ear, while helping to prevent the spread of infection.
Examine the external canal
Straighten the outer ear canal to make insertion of the speculum easier. For adults, retract the pinna upwards and backwards; for children under three, retract the pinna downwards and backwards.
Steer the scope into the canal as you look until you can see the tympanic membrane or anything that’s in the way.
Adjust the focus
The MacroView focusing wheel is in the default position when the green line, aligns the corresponding green dot on the side of the instrument. This allows you to focus for your own vision if needed using the wheel.
It may be necessary to adjust the position of the otoscope to get a complete view of the entire ear canal and all areas of the tympanic membrane.
Remove the speculum
After the examination, the used disposable speculum should be removed and discarded from the otoscope. Twist the speculum off by hand or rotate the MacroView ‘Tip Grip’ ring counter-clockwise to disengage the speculum.
Using the insufflator bulb
To help determine if there is fluid behind the drum (a sign of infection), you can use an insufflator bulb to gently puff air at the thin membrane. A lack of movement may be a clue that the ear has fluid, which may not be visible otherwise. Wlech Allyn SofSeal™ tips can help better seal against the canal wall – making it easier to see TM movement of the tympanic membrane.