The examination technique involves grasping the pinna and pulling it up and backwards (posteriorly and superiorly), which helps to straighten the ear canal and for inspection of the TM.
(In infants, only pull the pinna posteriorly not superiorly for examination.)Hold the otoscope near to the eyepiece rather than at the end; this helps to reduce the patient's discomfort due to hand movements, which are exaggerated in the ear.
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A foreign body, usually accompanied by an offensive unilateral discharge, may be seen inside the nose of a child.
A mirror and headlight or an endoscope instrument are used to view the nasopharynx (the postnasal space, which contains the Eustachian tube orifices and pharyngeal recess (of Rosenmüller) and may contain adenoids or nasopharyngeal cancer), but this is not always possible during a routine examination. Look for large nasal polyps and tumours arising from the soft palate.
An otoscope also has its own magnification, which gives a good view of the tympanic membrane (TM).
Batteries need to be fully operational to allow optimal light during examination.
Note the condition of the canal skin, and the presence of wax, foreign tissue, or discharge.
The mobility of the eardrum can be evaluated using a pneumatic speculum, which attaches to the otoscope. Move the otoscope in order to see several different views of the drum; it is not always possible to see the whole drum in one single view using an otoscope. In a normal drum the following structures can be identified: The nose can be inspected from the front to examine the anterior nares by lifting the tip of the nose up and looking inside without a speculum.