This document provides guidance on performing a thorough examination of the ear, including inspection, palpation, and various tests. It describes how to examine the external ear, ear canal, tympanic membrane, mastoid region, and surrounding areas. Examination findings are outlined for various normal and abnormal conditions. The document also mentions examining related structures like the nose, throat, eyes, respiratory and cardiovascular systems as part of a full ear examination.

2.  Mental state
 Consciousness
 Built and nutrition
 Attitude and Gait
 Facies
 Pallor – palmar creases, mm lips cheeks, conjuctiva,
nail beds
 Cyanosis – tongue (central), nail bed , tip of nose,
palmar skin
 Jaundice – sclera, nail bed , ear lobule, tip of nose
 Skin eruptions – macules ( change in skin colour),
papules , vesicles, pustules (solid projections)
 Neck nodes

3.  Pulse – pulse rate, rhythm (regular, irregular)
 Respiratory rate – fast, slow
 Temperature – continous ( fluctuates less
than 1 deg), remittent ( fluctuates more than
2 deg), intermittent
 Blood Pressure

4.  Examine the affected region
 Inspection
 Palpation
 Movements
 Measurements’
 LYMPH NODES
 General Examination- Cranial Nerves,
Respiratory
 CVS for surgery purpose

5.  External Ear
 - Auricle/Pinna
 - Pre auricular region
 - Post auricular/Mastoid region
 EAC
 TM
 Middle ear mucosa
 Eustachian tube
 Facial nerve and other CN
 Neck
 Nose and Throat

6.  INSPECTION
 Size – anotia (absence), microtia (small)
 Shape – cauliflower ear, bat ear (auricle
protrudes anteriorly)
 Colour- red (perichondritis)
 Position- displacement of auricle forwards,
laterally or inferiorly – mastoid abscess
 Swelling
 Scar
 Ulcer

8.  PALPATION
 Superficial palpation
 Using fingers (digital palpation) of cartilage and
soft tissue
 Soft tissue – mobility of skin (lost in malignancy),
thickening, swelling
 Raised temperature, tenderness
 Cartilage – defect or loss
 Deep palpation
 Tragal tenderness- inflammation
 Painful movement of pinna – acute otitis externa

9.  Sinus – pre auricular sinus
 Fistula
 Scar
 Swelling – cystic, lymphadenitis

10.  INSPECTION
 Scar, dermatitis, swelling, fistula
 Change in mastoid contour
 Normally – uneven bone, skin over it mobile
 PALPATION
 Superficial palpation
 Skin – mobile
 Raised temperature
 Swelling – margins, cystic (sebaceous cyst)
 Iron out mastoid – smooth surface –
coalescent mastoiditis

11.  Deep palpation
 Tenderness – mastoiditis
 1. Cymba concha – bony landmark for mastoid
antrum
 2. Midpoint of posterior border of mastoid
 3. Tip of mastoid
 NECK EXAMINATION
 Bezold’s abscess – pus track along SCM inferiorly
 Citelli’s abscess – pus track along digastric into
submandibular triangle
 Luc’s abscess – pus around zygoma
 IJV as hard cord on palpation along SCM – IJV
thrombosis

12.  Direct examination
 Without speculum
 Size of meatus – atresia/wide/narrow
 Wide – post op, syphilis, otosclerosis
 Narrow – congenital atresia, scar due to trauma,
burns tumour - osteoma
 Content of meatus – wax, discharge, FB, Polyp
 Digital examination –
 Adults – pinna pulled upwards, backwards and
laterally, tragus pulled forwards
 Children – pinna pulled downwards and laterally

14.  Look for furuncle, swelling
 Fungal infection (otomycosis) – black –
aspergillus niger, yellow – candida albicans
 Polyp – probe test – if probe all around – arise
from middle ear
 Impacted wax – whole EAC occluded
 Tumours
 With speculum examination – deep meatus to
straighten the canal
 Largest speculum which can enter
 Black coated
 Introduce in slow rotatory fashion upto cartilage
only

15.  Cough – vagal irritation
 Sagging of posterior superior EAC –
cholesteatoma, mastoid abscess, mastoiditis
 Absence of sensation in post sup EAC –
Hitselberger’s sign – mass lesion in CP angle

16.  Normal – pearly white colour, obliquely set,
anterior and posterior malleolar fold (longer)
 Handle of malleus – whitish bony landmark
 Umbo
 Cone of light/light relex – triangular in shape
anterio inferiorly – unreliable landmark
 Short or lateral process of malleus – small
yellowish prominence – at 12 o clock position -
always present – last landmark to be destroyed
in disease
 Quadrants – 4 – imaginary line through tip of
umbo, 2 nd vertically along handle of malleus –
ant sup/inf, post sup/inf

18.  Colour of TM – normal pearly white/greyish
white, red in ASOM, acute myringitis
 Congestion with yellowish tint – ASOM
 Diffuse congestion/ localised at handle of
malleus – ASOM
 Dark grey colour/dull appearance – tubal
occlusion
 Dull white/thickened cotton like drum – senile
sclerosis, scarring
 Chalky white appearance – tympanosclerosis
after otitis media
 Dull lusterless/bulging – secretory otitis media
 Blue drum – transudative otitis media
 Dark blue drum - haemotympanum

19.  TM normally inclined downwards and medially
 Protrude outwards – bulging drum – acute otitis
media (pus),Haemotympanum (blood),OME with
good ET function (air) – increase length of handle
of malleus, less prominent short process and
malleolar folds, absence of cone of light
 Pulled inwards – retracted TM- OME with poor ET
function, ET obstruction, atelectasis – shortening
of handle of malleus, more prominent short
process, anterior and post malleolar folds,
distorted cone of light
 Retraction – attic region (retraction pocket) if
deepens – cholesteatoma sac

21.  Siegle’s pneumatic speculum/ Valsalva
maneuvre
 Normal – change in shape of triangular light
reflex/ handle of malleus movement
 Decreased/absent – ET dysfunction, adhesive
otitis media (fixed), ankylosis of ossicular
chain, SOM
 Hypermobility – Patulous ET, atrophy of TM

23.  Perforation – ovoid/ kidney shaped/ round,
small, medium, large, sub total, total,
central/marginal, pars tensa/attic, dry/wet,
single/multiple (TB, measles, wegner’s
granulomatosis), margins – regular/irregular,
edge of perforation – thick (CSOM)/ thin
(ASOM)
 Scars
 Bulla – grey/red/bluish pearls like structures
attached to surface of TM
 Chalky white patch - tympanosclerosis

25.  Only through perforation/ if TM thinned out/
semitransparent
 Middle ear mucosa – oedema/ polyp
 Granulation tissue
 Ossicles, ET, round window, oval window
 FB
 Fistula

26.  Posterior rhinoscopy/ Nasopharyngoscopy/
DNE/ Through perforation
 Valsalva Maneuvre
 ET catheterisation – check patency of ET
 Few drops in ear if perforation and bitter
taste in mouth
 TUNING FORK TESTS
 Rinne’s
 Weber
 ABC

27.  FISTULA TEST
 Apply intermittent pressure on tragus/
siegle’s pneumatic speculum – ask patient to
look straight – check for vertigo/ nystagmus
towards opposite side
 FACIAL NERVE EXAMINATION
 Paralysis in ASOM, CSOM, Malignant otitis
externa, herpes zoster, tumours and trauma
 Wrinking of forehead/ closure of eyes/ loss
of naso labial folds/ deviation of angle of
mouth/ cant whistle or blow

28.  NOSE AND THROAT EXAMINATION
 Rhinitis/sinusitis
 Pharyngitis/tonsillitis/adenoids
 EYE EXAMINATION
 Nystagmus
 Corneal relex – absent in acoustic neuroma
 Blue sclera – osteogenesis imperfecta
 Papilloedema – CP angle tumours/ otitic
hydrocephalus/ temporal abscess
 Interstitial keratitis – congenital syphilis

29.  RS/CVS/CNS
 CN paralysis
 VI – petrous apex lesions
 IX, X, XI, XII – advanced malignant otitis
externa/ advanced glomus jugulare tumours
 AUSCULTATION
 Stethoscope over ear canal/ mastoid – bruits
heard in vascular lesions
 Stethoscope into EAM – transmitted sounds
heard in patulous ET