This document provides instructions for examining the ear, including the external ear, tympanic membrane, and inner ear structures. It describes how to position the patient and manipulate the pinna to view the ear canal. It explains how to hold the otoscope and identify structures of the normal tympanic membrane. Finally, it includes diagrams of ear anatomy labeling the external, middle, and inner ear components.

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Examination of the ear and
tympanic membrane

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Examination of pinna and adjacent
tissues
 Pinna
 size, shape, symmetry
 position, ulcers, lumps
 position, tenderness,
scars
 Lymph nodes
 particularly pre and
post auricular
 Mastoid
 tenderness
 Hearing aid
 Inspect the external
meatus
 discharge - blood / pus
 masses
 On insertion of the
speculum inspect the
canal
 skin
 discharge/debris
 swelling/masses
 wax
 calibre

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Otoscopy - position
 The patient should be
positioned with the head
flexed laterally away from
the examiner
 The external auditory canal
has a bend which normally
restricts the examiners view
The pinna of the ear to be examined is held firmly and
gently pulled upwards and backwards to straighten the
canal using the hand not holding the otoscope

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Holding the instrument 1
 Otoscope is held in the same
hand as the ear being
examined
 The speculum should be as
wide as possible to
comfortably fit into the ear
canal
 Holding the otoscope (like a
pen) horizontally provides a
secure cradle for the
instrument

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Holding the instrument 2
 The curled fingers can
rest against the cheek
and the handle will not
catch the shoulder (as it
may if held vertically)
 In addition, this position
will help protect against
accidentally pushing too
deeply into the outer ear

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Tympanic membrane
Attic
AnteriorPosterior
Light reflex
Umbo
Handle of malleus
Lateral process

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Inspection of the tympanic membrane
Identify the normal structures
There is significant variation in normal
appearance
Note
 colour, shape
 perforation
 scars
 ossicles
 light reflex

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Anatomy of the ear
 The ear is divided anatomically and clinically into
the external, middle and inner ear
 Note the external ear consists of a cartilaginous
and a bony part
 The bony part is painful if touched with a speculum
inserted too far (if too small a speculum used)
 Use this diagram to identify and label malleus,
incus, stapes, cochlea, semi-circular canals,
cochlear nerve, auditory nerve

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The anatomy of the ear
Middle Inner
External
Cartilaginous Bony

10. Presenting/recording findings
External structures
Auditory Canal
Tympanic Membrane
Light Reflex
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