otoscopia

Otoscopia is a basic clinical procedure used to examine the external auditory canal and the tympanic membrane (eardrum) with an otoscope. It is employed to assess ear pain, discharge, hearing loss, trauma, or screening for ear disease in both pediatric and adult patients.

During the examination, the clinician inspects the visible parts of the external canal, detects cerumen buildup, signs of inflammation, foreign bodies, or discharge, and assesses the tympanic membrane and its landmarks. Normal findings include a translucent, intact tympanic membrane with a visible cone of light and the malleus handle and umbo. The tympanic membrane should move with inflation or pneumatic otoscopy, indicating middle-ear mobility. In children, the ear canal may be narrower, which can affect visualization.

Equipment and technique involve using a handheld otoscope with disposable specula of appropriate size. The patient is positioned comfortably, and the clinician gently straightens the canal by pulling the pinna in the appropriate direction. The speculum is inserted with care to minimize pain or injury, and the canal is inspected with adequate illumination. Pneumatic otoscopy or tympanometry may be used to evaluate tympanic membrane mobility when indicated. Video otoscopy can provide documentation and education but is not essential for basic evaluation.

Common findings include cerumen impaction, which can cause conductive hearing loss; otitis externa, with canal erythema, edema, and possible otorrhea; and signs of otitis media, such as a bulging or obscured tympanic membrane. Other conditions detectable by otoscopy include tympanic membrane perforation, retraction pockets, cholesteatoma, and foreign bodies. Findings should be interpreted within the clinical context and by a trained clinician.

Limitations include variability in patient anatomy, discomfort, and the occasional inability to visualize the tympanic membrane due to cerumen, inflammation, or angulation of the ear canal.