From the Guidelines
Otoscopy is a crucial examination technique used to visualize the tympanic membrane (eardrum) and assess ear health, and it should be performed with a properly sized speculum and pneumatic otoscopy to assess for middle ear effusion when diagnosing otitis media with effusion (OME) in a child, as recommended by the clinical practice guideline: otitis media with effusion executive summary (update) 1.
Key Points to Consider
- To perform otoscopy correctly, use an otoscope with a properly sized speculum, gently pull the pinna upward and backward in adults (or downward and backward in children under 3), and insert the speculum carefully into the ear canal.
- A normal tympanic membrane appears pearly gray, translucent, and slightly concave with a cone of light reflection in the anteroinferior quadrant.
- The landmarks you should identify include the pars tensa (main portion), pars flaccida (superior portion), malleus handle, umbo (center point), and annulus (peripheral attachment).
- When examining, look for abnormalities such as redness, bulging, retraction, perforation, fluid levels, or bubbles behind the membrane.
- Common pathological findings include acute otitis media (red, bulging membrane), otitis media with effusion (amber or blue tympanic membrane with fluid level or bubbles), tympanic membrane perforation (visible hole), or cholesteatoma (white mass in the middle ear).
- Pneumatic otoscopy has been recommended as the primary diagnostic method for bacterial colonization because of its excellent diagnostic accuracy, and it can avoid false-positive diagnoses of OME caused by surface abnormalities in the tympanic membrane without middle ear effusion (MEE) 2.
Important Considerations
- The high prevalence of OME, along with many issues, including difficulties in diagnosis and assessing its duration, makes it essential to use pneumatic otoscopy to assess for middle ear effusion when diagnosing OME in a child.
- Proper otoscopy technique requires practice but is essential for accurate diagnosis of ear conditions and appropriate treatment planning.
- The clinical practice guideline: otitis media with effusion executive summary (update) recommends documenting the presence of middle ear effusion with pneumatic otoscopy when diagnosing OME in a child, and performing pneumatic otoscopy to assess for OME in a child with otalgia, hearing loss, or both 1.
From the Research
Otoscopy and Tympanic Membrane
- The tympanic membrane is a critical component of the ear, and its examination is essential in diagnosing various ear-related conditions 3.
- A red tympanic membrane can be a challenge for examiners, and a systematic approach to otoscopy, including a short directed history and functional examinations, can help make an accurate diagnosis 3.
- The differential diagnosis for a red tympanic membrane is extensive, including malformations, traumas, infections, and tumors, among others 3.
Otoscopy in Acute Otitis Media
- Acute otitis media (AOM) is a common condition in children, and otoscopy is a crucial diagnostic tool in assessing the tympanic membrane 4, 5, 6.
- Studies have shown that antibiotics may not significantly reduce pain at 24 hours but can reduce pain at two to three days and have a modest effect on tympanic membrane perforations and contralateral otitis episodes 5, 6.
- The use of antibiotics in AOM should be weighed against the potential harms, including adverse events such as vomiting, diarrhea, or rash 5, 6.
Diagnostic Tools and Tympanic Membrane Abnormalities
- Video otoscopy, multifrequency tympanometry, and otoreflectance are diagnostic tools that can help detect tympanic membrane abnormalities and middle ear pathology 7.
- Understanding the relationship between these diagnostic tools and anatomical abnormalities can enhance the interpretation of audiologic results and improve diagnosis and treatment of ear-related conditions 7.