Ear Examination

An ear examination is a thorough evaluation of the ears that is done to screen for ear problems, such as hearing loss, ear pain, discharge, lumps, or objects in the ear. An ear examination can detect problems in the ear canal, eardrum, and the middle ear, such as infection, excessive earwax, or an object like a bean or a bead.

During an ear examination, an instrument called an otoscope is used to look at the outer ear canal and eardrum. An otoscope is a handheld instrument with a light, a magnifying lens, and a funnel-shaped viewing piece with a narrow, pointed end called a speculum. A pneumatic otoscope has a rubber bulb that your health professional can squeeze to give a puff of air into the ear canal. This allows your health professional to see how the eardrum responds.

An ear examination may be done:

• As part of a routine physical examination.
• To screen babies and children for hearing loss.
• To determine the cause of symptoms such as earache, a feeling of pressure or fullness in the ear, or hearing loss.
• To check for excess wax buildup or an object in the ear canal.
• To detect the location of an ear infection. The infection may involve only the external ear canal (otitis externa) or the middle ear behind the eardrum (otitis media).
• To monitor the effectiveness of treatment for an ear problem.

It is important to sit very still during an ear examination. A young child should be lying down with his or her head turned to the side or sitting on the lap of an adult with the child's head resting securely on the adult's chest. Older children and adults can sit with the head tilted slightly toward the opposite shoulder.

Your health professional may need to remove earwax in order to see the eardrum.

An ear examination can be done in a health professional's office, a school, or the workplace.

For an ear examination, the health professional uses a special instrument called an otoscope to look into the ear canal and see the eardrum.

Your health professional will gently pull your ear back and slightly up to straighten the ear canal. If a baby under 12 months is being examined, the ear will be pulled downward and out to straighten the ear canal. The health professional will then insert the pointed end (speculum) of the otoscope into your ear and gently move the speculum through the middle of your ear canal to avoid irritating the canal lining. The health professional will look at each eardrum (tympanic membrane).

Using a pneumatic otoscope lets your health professional see what the eardrum looks like and how well it moves when the pressure inside the ear canal is changed. It helps your health professional determine if there is a problem with the eustachian tube or fluid behind the eardrum (otitis media with effusion). A normal eardrum will flex inward and outward in response to the changes in pressure.

The physical examination of the ear using an otoscope is usually painless. If you have an ear infection, inserting the otoscope into the ear canal may cause some pain or mild discomfort.

The pointed end of the otoscope can irritate the lining of the ear canal, but this can usually be avoided by inserting the otoscope slowly and carefully. If the otoscope does scrape the lining of the ear canal, it rarely causes bleeding or infection.

An ear examination is a thorough evaluation of the ears that is done to screen for ear problems, such as ear pain, discharge, lumps, or objects in the ear.

Factors that can interfere with your test or the accuracy of the results include:

• Earwax, dirt, or an object such as a bean or a bead hiding or blocking the eardrum (tympanic membrane) in the ear canal. Your health professional may need to clean the ear canal before examining the ear.
• Crying. A small child who is upset or crying may have red eardrums. This redness may be confused with an ear infection.
• The inability of some children to sit still during the examination.

• Other types of tests may be used to examine the ear and evaluate hearing. These tests include:
  • Acoustic immitance testing (tympanometry and acoustic reflex testing). This 2- to 3-minute test measures how well the middle ear relays sound. The soft tip of a small instrument is inserted into the ear canal and adjusted to achieve a tight seal. Sound and air pressure are then directed toward the eardrum. The test is not painful, but slight changes in pressure may be felt or the tone may be heard.
  • Vestibular tests (falling and past-pointing tests). These tests can detect problems with areas of the inner ear that help control balance and coordination. During these tests, you will try to maintain your balance and coordination while moving your arms and legs in certain ways, standing on one foot, standing heel-to-toe, and performing other maneuvers with your eyes open and closed. Your health professional will make sure that you do not fall.
• If your child has repeat ear infections, your health professional may suggest that you buy a simple otoscope that is available for home use.