From the Guidelines
Otoscopy, specifically pneumatic otoscopy, should be performed by a clinician, such as an otolaryngologist (ENT specialist) or a primary care physician, to examine the tympanic membrane and diagnose conditions like otitis media with effusion (OME) in children, as recommended by the 2016 clinical practice guideline 1. When performing otoscopy, the healthcare provider uses an otoscope to visualize the tympanic membrane and ear canal. The procedure involves gently pulling the pinna (outer ear) upward and backward in adults (or downward and backward in children) to straighten the ear canal, then inserting the speculum to visualize the tympanic membrane. Key points to consider when performing otoscopy include:
- Using pneumatic otoscopy to assess for OME in children with otalgia, hearing loss, or both, as recommended by the guideline 1.
- Documenting the presence of middle ear effusion with pneumatic otoscopy when diagnosing OME in a child, as stated in the guideline 1.
- Considering referral to a pediatric otolaryngologist for infants, children, and adolescents with complicated infections that may require surgery involving the ear, such as otitis media with effusion and hearing change, as suggested by the 2014 referral guidelines 1. A normal tympanic membrane appears pearly gray, translucent, and intact with a cone of light reflection in the anteroinferior quadrant. Otoscopy helps diagnose conditions such as otitis media (middle ear infection), otitis externa (swimmer's ear), tympanic membrane perforation, cholesteatoma, and foreign bodies in the ear canal. While any physician can perform basic otoscopy, ENT specialists have advanced training for more complex ear examinations and procedures, including microscopic otoscopy for detailed visualization. In terms of specialty, an otolaryngologist (ENT specialist) is the most appropriate doctor to perform otoscopy, especially for complex cases or when pneumatic otoscopy is required, due to their advanced training and expertise in ear examinations and procedures 1.
From the Research
Otoscopy and Tympanic Membrane Examination
- Otoscopy is a crucial diagnostic tool for examining the tympanic membrane and diagnosing otitis media, as stated in the study 2.
- The study 3 highlights the importance of otoscopy in diagnosing otitis media with effusion, acute otitis media, and no effusion cases, with an agreement of 57% among four otolaryngologists.
- A smartphone-enabled otoscope can capture tympanic membrane images and has been shown to be effective in detecting and evaluating tympanic membrane pathology, with a correct diagnosis of 96% of normal tympanic membranes and 100% of abnormal tympanic membranes 4.
Specialty Doctor for Otoscopy and Tympanic Membrane Examination
- Otolaryngologists (Ear, Nose, and Throat doctors, ENTs) are the specialty doctors who perform otoscopy and examine the tympanic membrane to diagnose otitis media and other middle ear disorders, as mentioned in the studies 2, 3, and 4.
- The study 5 proposes an automatic diagnostic algorithm for detecting otitis media based on otoscopy images of the tympanic membrane, which can assist specialty doctors in making accurate diagnoses.
Diagnostic Tools and Techniques
- Pneumatic otoscopy is a technique used to improve the accuracy of middle ear diagnosis, as described in the study 2.
- Wideband tympanometry is a measurement technique that can provide valuable information in addition to otoscopy images, increasing diagnostic certainty and agreement among ENTs, as shown in the study 3.
- Tympanometry is a useful quantitative tool for evaluating otitis media with effusion and acute otitis media, providing information about the presence of fluid in the middle ear, mobility of the middle ear system, and ear canal volume 6.