Ear Examination

Ear Examination w/ Auriscope.

-------------------------------

sequence of events

1. GIEP, wash hands
2. inspection of the outer ear
3. Palpation of the ear
4. Check auriscope function and fit speculum
5. use of auriscope
6. report on appearance of timpanic membrane
7. thank, wash hands and leave

-------------------------------

inspection of the outer ear

• Look at the pinna, noting its shape, size and any deformity.
• Look behind the ears for any scars from surgery
• See if the patient wears a hearing aid. Ask the patient to remove it before you go any further.
• Look at the size of the meatus. If it is very wide this suggests previous mastoid surgery.
• Note any discharge or colour change in the skin.
• report.

-------------------------------
Palpation of the ear

• Gently pull on the pinna and ask the patient if it is painful. Tenderness on palpation of the tragus (the bit that juts out just anterior to your ear canal) suggests infection of the external auditory meatus or temporomandibular joint problems.
• palpate the pre-auricular (in front of the ear, just below temples) and post-auricular (behind the ear, where skull bones jut out) lymph groups for any lymph node enlargement.
• report.

-------------------------------

Check auriscope function and fit speculum

• just make sure that the auriscope works by turning it on, and flashing the light onto your palm.
  if it doesn't work, congrats, you can blame your examiner for failing CSU. (just kidding)
• Explain to the patient what you're going to do.
  ("I will now insert this into your ear to check how things are inside. this would be a little uncomfortable but it shouldn't cause any pain. please bear with me okay?". if not, patient will assume you think "IMMA HURT YOU REAL GOOD, BITCH" because instruments look very scary.)
  
• comment that you will use a suitable - sized speculum. large enough to see the ear canal clearly, but small enough to fit the ear and NOT cause any pain. but the size doesn't matter - its the skill. seriously. (which means if you're not sure, don't choose the big ones because what if it doesn't fit the ear?)

-------------------------------

use of auriscope

• use of auriscope requires practice or you'll hurt your SP. so make sure you practice.
• the auriscope should be held with a pen grip between your index finger and thumb with the ulnar border of your hand against the patient's cheek. (meaning your hand holding the auriscope should be resting against your patient's face)
  this is to minimize damage shall the patient move while looking into the ear.
• Gently pull the pinna upwards and backwards to straighten the cartilaginous external auditory meatus
• Introduce the speculum and inspect the skin of the external auditory meatus for infection, wax and foreign bodies.
• Look at the tympanic membrane. You should be able to see a cone of light as the concave surface of the tympanic membrane reflects the light forwards - the light reflex. Look for the anatomical features in a systematic fashion.
• report after you have seen everything inside and pulled out the auriscope. - this is to minimise the time the auriscope is inserted into the patient's ear.

there is a lot of practice required for you to see the tympanic membrane, but looking towards the direction of the eye-ball will help locate the general location.

-------------------------------
report on appearance of timpanic membrane

• comment that the timpanic membrane is present.
  (if not, you're doing it wrong or worse, you have successfully perforated your patient's eardrum. oops.)
• comment if there is any inflammation, pus, exudates, or gadgets attached (e.g. grommet)
• comment on the cone of light - is it present? on what direction? 
• comment on the handle of mallulus. is it present?
• repeat on the other ear, after you have changed the earpiece. (to prevent infection from one ear to spread to the other)

-------------------------------
thank, wash hands and leave

-------------------------------