Otoskopia

Otoscopy is a clinical examination used to inspect the external auditory canal and the tympanic membrane. It is performed with an otoscope, a handheld instrument with a light, a magnifying lens, and a disposable speculum. Some devices are video-based and can display the view on a screen, or include pneumatic capability to test membrane mobility.

Indications include ear pain, hearing loss, discharge, trauma, or suspected middle-ear disease. The exam is commonly performed in primary care and by ENT specialists as part of a routine evaluation of the ear.

Technique: The patient is seated. For adults, the pinna is gently pulled up and back to straighten the ear canal; for young children, it is often pulled down and back. The speculum is inserted gently, avoiding excessive pressure. The canal is inspected for cerumen, debris, or discharge, and the tympanic membrane is examined. Key landmarks include the cone of light, the manubrium of the malleus, and the umbo. If present, signs of perforation or retraction pockets are noted. Pneumatic otoscopy can assess TM mobility by insufflating air; absence of mobility suggests effusion or other middle-ear pathology.

Findings: A normal TM is pearly gray, translucent, and slightly concave. Abnormal findings include a bulging, reddened TM in acute otitis media, a retracted TM in Eustachian tube dysfunction, a perforation, or an effusion with a visible air-fluid level. The external canal may show otitis externa with edema and discharge, or cerumen impaction that blocks visualization.

Limitations and adjuncts: Visualization is limited to the external canal and tympanic membrane; deeper middle-ear structures require additional tests such as tympanometry, audiometry, imaging, or referral.