How It Is Done
If you are going to examine a young child, have the child lie down with his or her head turned to the side, or have the child sit on an adult's lap and rest his or her head on the adult's chest. Older children or adults can sit with their head tilted slightly toward the opposite shoulder. Sitting is the best position for identifying otitis media with effusion (fluid behind the eardrum).
Select the largest viewing piece that will fit easily into the ear canal, and attach it to the otoscope.
If the person is only having problems with one ear, examining the other ear first may make it easier to determine what is different about the affected ear.
When checking the ear of a child older than 12 months or an adult, hold the otoscope in one hand and use your free hand to pull the outer ear gently up and back. This straightens the ear canal and improves visualization. In babies younger than 12 months, gently pull the outer ear down and back.
Now, slowly insert the pointed end of the viewing piece into the ear canal while looking into the otoscope. The sides of the ear canal can be quite sensitive, so try not to put pressure on the ear canal. It may help to steady your hand on the person's face so your hand moves along with their head in case they move quickly.
Do not move the otoscope forward without looking into it. Make sure you can see the path through the ear canal. You do not need to insert the viewing piece very far into the ear—the light extends well beyond the viewing tip.
Angle the tip of the viewing piece slightly toward the person's nose to follow the normal angle of the canal. While looking through the otoscope, move it gently at different angles so that you can see the canal walls and eardrum. Stop at any sign of increased pain.
Ask your doctor to review this technique with you and to watch you do an examination. Then practice on some healthy, willing adults so you can learn what a normal ear canal and eardrum look like. Don't be discouraged if you can't see the eardrum at first—it takes some practice and experience.