From the Guidelines
Otoscopy is a medical procedure used to examine the ear canal and tympanic membrane, and it is not related to Tempranillo, which is a variety of grape used in wine production. During otoscopy, a healthcare provider uses an instrument called an otoscope to visualize the external ear canal and tympanic membrane. The normal tympanic membrane appears pearly gray, translucent, and intact with a cone of light reflection in the anteroinferior quadrant. When examining the tympanic membrane, clinicians look for signs of infection (redness, bulging), perforation, retraction, or fluid behind the membrane.
Key Points to Consider
- Otoscopy is the mainstay of AOM diagnosis, as stated in the study published in Nature Reviews Disease Primers 1.
- A bulging tympanic membrane is the most consistent sign of AOM and is the most useful feature for differentiating AOM from OME, according to the study published in Nature Reviews Disease Primers 1.
- Pneumatic otoscopy is the primary diagnostic method for OME, as recommended by the AAP, AAFP, and AAO-HNS guideline published in American Family Physician 1.
- The correct diagnosis of OME is essential to proper management, and differentiating OME from AOM will avoid the use of unnecessary antimicrobial agents, as stated in the guideline published in American Family Physician 1. This procedure is commonly performed to diagnose ear infections, foreign bodies in the ear canal, or other ear pathologies. Proper technique involves gently pulling the pinna upward and backward in adults (or downward and backward in children) to straighten the ear canal for better visualization. If you're experiencing ear pain, hearing loss, or discharge, an otoscopic examination by a healthcare professional is recommended for proper diagnosis and treatment.
Diagnostic Modalities
- Otoscopy: visual examination of the ear canal and tympanic membrane with an otoscope, as described in the study published in Nature Reviews Disease Primers 1.
- Pneumatic otoscopy: examination of the middle ear using an otoscope to create an air-tight seal in the ear canal and then squeezing (or releasing) the attached rubber bulb to change the pressure in the ear canal and see how the tympanic membrane reacts, as recommended by the AAP, AAFP, and AAO-HNS guideline published in American Family Physician 1.
- Tympanometry: an objective measure of middle ear function that requires an air-tight seal in the ear canal, as described in the study published in Nature Reviews Disease Primers 1.
From the Research
Otoscopy and Tympanic Membrane Perforation
- Otoscopy is a crucial diagnostic tool for examining the tympanic membrane and middle ear disorders 2, 3.
- Pneumatic otoscopy, in particular, allows for the inspection of the tympanic membrane and its movement, providing valuable information in the diagnosis of middle ear disorders 3.
- However, in cases of tympanic membrane perforation, pneumatic otoscopy should be avoided, as it may cause further damage or discomfort to the patient 4.
Tympanic Membrane Perforation Characteristics
- The size and location of the perforation can affect the degree of conductive hearing loss, with larger perforations and those involving the posterior quadrants or manubrium resulting in higher air-bone gaps 5.
- The etiology of the perforation, whether traumatic, inflammatory, or iatrogenic, can also impact the degree of hearing loss, with inflammatory causes showing higher bone and air conduction pure-tone averages 5.
- The presence of myringosclerosis, umbo or manubrium involvement, and the affected quadrants can also influence the degree of hearing loss 5.
Diagnostic Techniques
- Optical Coherence Tomography (OCT) is a high-resolution noninvasive imaging technique that offers promise as a diagnostic aid for otologic conditions, such as otitis media, cholesteatoma, and conductive hearing loss 2.
- OCT vibrometry can image the nanoscale vibrations of the tympanic membrane and middle ear, detecting the location of ossicular chain dysfunction and differentiating between stapes fixation and incus-stapes discontinuity 2.
- Electroacoustic impedance bridges can provide valuable information in the diagnosis of middle ear disorders, particularly when used in combination with pneumatic otoscopy 3.