Definition & Overview

Otoscopy is a diagnostic procedure that examines the inner structures of the ear using a specialised device called the otoscope or auriscope. It is primarily performed to diagnose any abnormalities or conditions that affected the ear, particularly its middle part where structures responsible for hearing and balance are found.

Otoscopes are composed of three general parts - the head, the handle, and the cone. The handle is used to grip the device and contains the power source for the light emitted by the device while the head is where the light bulb and a low-power magnifying lens are located. The cone, on the other hand, is the extended part that is inserted into the ear canal. Otoscopes come in several sizes, from the large wall-mounted ones powered by electricity to the more common handheld devices that are powered by batteries. This device is either monocular or binocular.

Who Should Undergo and Expected Results

The procedure can be performed to diagnose the following conditions:

  • Ear eczema - A condition characterised by constant itchiness inside the ear and is indicative of an ongoing inflammation. The ear canal would appear dry with a flaky lining.
  • Otitis media – A condition characterised by the inflammation of the inner ear due to bacterial infection. The ear canal becomes swollen, resulting in persistent pain and temporary decreased hearing ability. There is also fluid discharge, possibly a combination of pus and blood.
  • Conditions affecting the eardrum or tympanic membrane, such as tympanosclerosis and perforation – These conditions are diagnosed with the use of a modified version of this procedure. Termed pneumatic otoscopy, it involves introducing pressure to determine how the tympanic membrane moves in response. An immobile eardrum is an indication of effusion in the middle ear.


The procedure can also be performed to visualise and remove earwax or cerumen. Some models of otoscopes allow the replacement of lens with specialised instruments that can be used to remove not just earwax but also foreign bodies that are lodged in the ear canal.

Considered a very simple procedure, otoscopy is performed in an outpatient or clinic setting, with physicians able to make a diagnosis the same day. There is little to no pain associated with this procedure. With fast diagnosis, patients are often prescribed the appropriate drug treatment before leaving the physician’s clinic.

How is the Procedure Performed?

The procedure starts with examining the external structures of the ear for any redness or swelling that may indicate the real condition of the ear. The physician then pulls the outer part of the ear gently to straighten the ear canal. This manoeuvre also provides better visual access to the eardrum or tympanic membrane. The cone is then inserted into the ear, and the physician peeks into the other end to examine the lining of the ear canal and checks the condition of the eardrum. Some physicians may perform insufflation by introducing a small puff of air into the canal and see if the eardrum moves. The patient is also asked to pinch their nose, close their lips, and blow out air. The physician will try to determine if there is slight movement in the eardrum while the patient performs the said tasks. An immobile eardrum is an indication of a blocked Eustachian tube.

Possible Risks and Complications

Some patients report a slight discomfort during the procedure, especially during the insertion of the cone into a swollen and inflamed ear canal.

There is also a possibility of tearing or perforation of the eardrum in an effort to relieve pressure and pain. In most cases, the tear resolves on its own. In rare instances, the tear may cause long-term reduced hearing capabilities with ossicular chain dislocation.

Other possible complications reported after otoscopy are related to the balance regulation function of the inner ear. Some patients complain of dizziness, imbalance, and vertigo. There are also reports of vomiting and nausea.

References:

  • Winther B, Doyle WJ, Alper CM. A high prevalence of new onset otitis media during parent diagnosed common colds. Int J Pediatr Otorhinolaryngol. 2006 Oct. 70(10):1725-30.

  • Takata GS, Chan LS, Morphew T, Mangione-Smith R, Morton SC, Shekelle P. Evidence assessment of the accuracy of methods of diagnosing middle ear effusion in children with otitis media with effusion. Pediatrics. 2003 Dec. 112(6 Pt 1):1379-87.

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