Home Ear Examination

Why It Is Done

A home ear examination may be done to:

• Look for signs of infection when a person has an earache or when a young child has vague symptoms.
• Check for a foreign object in the ear, such as an insect or a bean.
• Check for earwax buildup when a person complains of hearing loss or of fullness or pressure in the ear.

How To Prepare

No special preparation is needed before having this test. Always remember to clean the ear speculum in hot, soapy water before using it.

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.

How It Feels

Examining a healthy ear using an otoscope is usually painless but may cause some mild discomfort if the person being examined has an ear infection.

Risks

The pointed end of the otoscope can irritate the lining of the ear canal. Make sure that you insert the otoscope slowly and carefully. If you do scrape the lining of the ear canal, it rarely causes bleeding or infection, but you must be careful to avoid pain or injury.

An otoscope can push an object closer to the eardrum. If you suspect an object in the ear, do not move the otoscope forward once you see the object. Don't try to remove the object—seek medical help.

There is a slight risk of damaging the eardrum if the otoscope is inserted too far into the ear canal. Do not move the otoscope forward if it feels like something is blocking it.

Results

Ear canal

Normal:	Ear canals vary in size, shape, and color. The ear canal is skin-colored and contains small hairs and usually some yellowish brown or reddish brown earwax.
Abnormal:	Wiggling or pulling on the outer ear causes pain. The ear canal is red, tender, swollen, or filled with pus.

Eardrum

Normal:

The eardrum is pearly white or light gray, and you can see through it. You can see the tiny bones of the middle ear pushing on the eardrum. You see a cone of light, known as the "light reflex," reflecting off the surface of the eardrum. This cone of light is at the 5 o'clock position in the right ear and at the 7 o'clock position in the left ear.

Abnormal:

The light reflex on the eardrum is dull or absent The eardrum is red and bulging. You can often see amber liquid or bubbles behind the eardrum. You can see a hole in the eardrum (perforation). You can see whitish scars on the surface of the eardrum. If your child has had a tube placed in an ear, you may also see the tiny plastic tube, which is usually blue or green. The eardrum is blocked by earwax or an object, such as a bean or a bead.