From the Guidelines
When performing otoscopy, the pinna should be pulled up and back in adults and children older than 3 years, but down and back in infants and children younger than 3 years. This recommendation is based on the anatomical differences in the ear canal between age groups, which affects the visualization of the tympanic membrane during otoscopy 1.
Key Considerations
- In adults and older children, the ear canal curves downward and forward, requiring the pinna to be pulled up and back to straighten the canal for better visualization.
- In infants and young children, the ear canal is straighter but angled upward, necessitating the pinna to be pulled down and back to align the canal properly.
- Using the correct technique is crucial to prevent discomfort and improve the accuracy of otoscopic examinations or treatments.
Clinical Implications
- The technique of pulling the pinna up and back or down and back is essential for effective otoscopy and administration of ear drops.
- The anatomical difference in the ear canal between age groups is due to the continued development of the ear canal throughout early childhood, which gradually changes its orientation as the child grows.
- Accurate diagnosis and treatment of conditions such as acute otitis externa (AOE) rely on proper otoscopy techniques, including the correct manipulation of the pinna 1.
From the Research
Otoscopy Techniques
When performing otoscopy, the direction of pinna pull can vary depending on the patient's age and ear anatomy.
- For adults and children over 3 years, the pinna is typically pulled up and back to straighten the ear canal and provide a better view of the tympanic membrane 2.
- For children under 3 years, the pinna is often pulled down and back to facilitate visualization of the ear canal and tympanic membrane 3, 4.
Considerations for Ear Anatomy
It's essential to consider the individual's ear anatomy and any potential conditions that may affect the ear canal or tympanic membrane, such as cerumen impaction or aural foreign bodies 3, 4, 5.