Otoscopy Procedure

Map the direction of the ear canal before inserting the specula

Your goal when inserting the specula is to be able to see the entire canal as you move in, find the ear drum at the end of the canal, and do it while keeping the patient comfortable. To do this, you need to map the bends and direction of the ear canal before inserting the specula. Without inserting the specula, with your dominant hand, pull the patient's pinna away from their head and upward, look down their ear canal with your naked eye (shining the Tympa otoscope light can help if it too dark). Pulling on the ear doesn't hunt (unless its your mother that does it). Looking with your naked eye and the light, consider two things: 1. Canal diameter- is the patient's ear a normal size? or do I need to use the smaller 2.5 mm specula? 2. Bends and direction- you are mapping how you will insert the specula. Does the canal bend towards the nose and then towards the back of the head? Does it go up and then down? Now you can insert the specula following the canal direction.

Examine the ear (pinna) and mastoid bone

If you've ever tried to see behind your own ear, you'll know that it is difficult. Check the skin on the pinna and mastoid (hard bone directly behind the ear) for skin lesions or questionable moles/tags. If you see something, you can ask the patient if they knew it was there and suggest that they get it checked outif they haven't already. When examining the mastoid bone, press on it firmly once to confirm that the bone feels firm and that pressing does not appear to cause the patient discomfort. If the patient reacts or the bone feels soft to the touch, ask the patient if they have any any infections or ear surgeries they didn't report during the case history.

Move patient (if needed) to identify all landmarks of the ear drum

You may need to make slight adjustments to the patient's posture to find all landmarks. There are two patient posture adjustments that will bring them into view. Ask the patient to do the following: 1. "Please look a little to your left." "Perfect, thank you. Now please do the same to the right."" This will allow you to see the sides of the ear drum, and find the cone of light. 2. "Please tilt your head away from me, as if you were going to lay it down on a pillow." This will allow the pars flaccida region to come into view.

Proceed medially past the ear canal hairs

Remember that ear canal hair only grows in the outer half? Once you get the tip of the specula past the hair, you'll have a clear view of the ear drum. If you see any hair in view, proceed deeper until it disappears. Once you're past the ear canal hair, you can release the patient's pinna. If you have trouble finding the ear drum, aim your specula towards the darkest/shadowy part of the ear.

Expand the view to the edges for the best view.

You want to make it as easy to see as possible. Expand the view by touching the screen with your thumb and index finger and expanding them outward so the edges of the circular view touch the edges of the phone so that the otoscopy view takes up as much space on the screen as possible.

Adjust the camera's focus by tapping on the screen and sliding the focus bar

Just like when taking pictures, you adjust the camera's zoom based on how far away from you the subject is standing. Same thing with the Tympa. If you want a good picture of a peice of wax or possible pathology on the outer canal, you'll need to adjust the focus to clearly capture it at that depth. You'll likely adjust the focus once or twice in each ear. To adjust the focus, tap the screen once and a focus bar will appear at the top. Slide the focus bar + or - until the area of interest comes into focus.