Examining the ear

You should now be ready to examine the ear. You should start by inspecting the pinna and checking the pre- and post-auricular regions. i.e in front and behind. Look at the pinna and comment on its size and shape. Look for scars which may be present from previous surgery or trauma to the ear. Hearing aids and cochlear implants are often found in the post-auricular region and many patients attempt to "hide" them under their hair. If they do have any form of hearing aid ask about the history. Why have they been wearing it and for how long? This information may help guide your clinical examination.

Some conditions that are associated with the pinna include:

  • Protruding ears also known as "Bat ears"
  • Haematoma as the result of trauma
  • Pre-auricular sinus which can be a potential route of infection
  • Accessory auricles which are small cartilage tags
  • Microtia which is the failed development of the pinna
  • Skin cancer such as basal cell carcinoma (BCC) or squamous cell carcinoma (SCC)

Finally, before placing the otoscope in the ear check that there are no visible foreign bodies. It is easier to take them out now rather than risk pushing them further into the canal.

 

 

As the video demonstrates it is important to hold the otoscope in the correct "pen grip" position. This allows the clinician to have better control of the instrument. Some clinicians may also suggest resting your little finger on the patients cheek. Pulling the pinna back before placing the otoscope helps to straighten the natural curvature of the canal, allowing a better view and more comfortable placement in the ear for the patient.