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An otoscope or auriscope is a
medical device A medical device is any device intended to be used for medical purposes. Significant potential for hazards are inherent when using a device for medical purposes and thus medical devices must be proved safe and effective with reasonable assura ...
which is used to look into the
ear An ear is the organ that enables hearing and, in mammals, body balance using the vestibular system. In mammals, the ear is usually described as having three parts—the outer ear, the middle ear and the inner ear. The outer ear consists of ...
s. Health care providers use otoscopes to screen for illness during regular check-ups and also to investigate ear symptoms. An otoscope potentially gives a view of the ear canal and tympanic membrane or eardrum. Because the eardrum is the border separating the external ear canal from the middle ear, its characteristics can be indicative of various diseases of the middle ear space. The presence of
earwax Earwax, also known by the medical term cerumen, is a brown, orange, red, yellowish or gray waxy substance secreted in the ear canal of humans and other mammals. It protects the skin of the human ear canal, assists in cleaning and lubrication, ...
(cerumen), shed skin, pus, canal skin edema, foreign body, and various ear diseases can obscure any view of the eardrum and thus severely compromise the value of otoscopy done with a common otoscope, but confirm the presence of obstructing symptoms. The most commonly used otoscopes consist of a handle and a head. The head contains a light source and a simple low-power
magnifying lens A magnifying glass is a convex lens that is used to produce a magnified image of an object. The lens is usually mounted in a frame with a handle. A magnifying glass can be used to focus light, such as to concentrate the sun's radiation to crea ...
, typically around 8
diopter A dioptre (British spelling) or diopter (American spelling) is a unit of measurement with dimension of reciprocal length, equivalent to one reciprocal metre, 1 dioptre = 1 m−1. It is normally used to express the optical power of a lens or cur ...
s (3.00x Mag). The
distal Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position pro ...
(front) end of the otoscope has an attachment for disposable plastic ear specula. The examiner first straightens the
ear canal The ear canal (external acoustic meatus, external auditory meatus, EAM) is a pathway running from the outer ear to the middle ear. The adult human ear canal extends from the pinna (anatomy), pinna to the eardrum and is about in length and in di ...
by pulling on the pinna (usually the earlobe, side or top) and then inserts the ear speculum side of the otoscope into the external ear. It is important to brace the hand holding the otoscope against the patient's head to avoid injury to the ear canal by placing the index finger or little finger against the head. The examiner can then look through a lens on the rear of the instrument and see inside the ear canal. In many models, the lens can be removed, which allows the examiner to insert instruments through the otoscope into the ear canal, such as for removing earwax. Most models also have an insertion point for a bulb capable of pushing air through the speculum which is called pneumatic otoscope. This puff of air allows an examiner to test the mobility of the
tympanic membrane In the anatomy of humans and various other tetrapods, the eardrum, also called the tympanic membrane or myringa, is a thin, cone-shaped membrane that separates the external ear from the middle ear. Its function is to transmit sound from the a ...
. Many otoscopes used in doctors offices are wall-mounted while others are portable. Wall-mounted otoscopes are attached by a flexible power cord to a base, which serves to hold the otoscope when it's not in use and also serves as a source of electric power, being plugged into an
electric outlet AC power plugs and sockets connect electric equipment to the alternating current (AC) mains electricity power supply in buildings and at other sites. Electrical plugs and sockets differ from one another in voltage and current rating, shape, si ...
. Portable models are powered by
batteries Battery most often refers to: * Electric battery, a device that provides electrical power * Battery (crime), a crime involving unlawful physical contact Battery may also refer to: Energy source *Automotive battery, a device to provide power t ...
in the handle; these batteries are usually rechargeable and can be recharged from a base unit. Otoscopes are often sold with
ophthalmoscope Ophthalmoscopy, also called funduscopy, is a test that allows a health professional to see inside the fundus of the eye and other structures using an ophthalmoscope (or funduscope). It is done as part of an eye examination and may be done as part ...
s as a diagnostic set. Diseases which may be diagnosed by an otoscope include
otitis media Otitis media is a group of inflammatory diseases of the middle ear. One of the two main types is acute otitis media (AOM), an infection of rapid onset that usually presents with ear pain. In young children this may result in pulling at the ear, ...
and
otitis externa Otitis externa, also called swimmer's ear, is inflammation of the ear canal. It often presents with ear pain, swelling of the ear canal, and occasionally decreased hearing. Typically there is pain with movement of the outer ear. A high fever is ...
, infection of the middle and outer parts of the ear, respectively. Otoscopes are also frequently used for examining patients' noses (avoiding the need for a separate nasal speculum) and (with the speculum removed) upper throats. The most commonly used otoscopes—those used in emergency rooms, pediatric offices, general practice, and by internists- are monocular devices. They provide only a two-dimensional view of the ear canal, its contents, and usually at least a portion of the eardrum, depending on what is within the ear canal and its status. Another method of performing otoscopy (visualization of the ear) is use of a binocular microscope, in conjunction with a larger plastic or metal ear speculum, with the patient supine and the head tilted, which provides a much larger field of view and the added advantages of a stable head, far superior lighting, and most importantly, depth perception. A binocular (two-eyed) view is required in order to judge depth. If wax or another material obstructs the canal and/or a view of the entire eardrum, it can easily and confidently be removed with specialized suction tips and other microscopic ear instruments, whereas the absence of depth perception with the one-eyed view of a common otoscope makes removal of anything more laborious and hazardous. Another major advantage of the binocular microscope is that both of the examiner's hands are free, since the microscope is suspended from a stand. The microscope has up to 40x power magnification, which allows much more detailed viewing of the entire ear canal, and of the entire eardrum unless edema of the canal skin prevents it. Subtle changes in the anatomy are much more easily detected and interpreted than with a monocular view otoscope. Traditionally only
ENT Ents are a species of beings in J. R. R. Tolkien's fantasy world Middle-earth who closely resemble trees; their leader is Treebeard of Fangorn forest. Their name is derived from an Old English word for giant. The Ents appear in ''The Lor ...
specialists (otolaryngologists) and otologists (subspecialty ear doctors) acquire binocular microscopes and the necessary skills and training to use them, and incorporate their routine use in evaluating patient's ear complaints. Studies have shown that reliance on a monocular otoscope to diagnose ear disease results in a more than 50% chance of misdiagnosis, as compared to binocular microscopic otoscopy. The expense of acquiring a binocular microscope is only one obstacle to its being more widely adapted to general medicine. The low level of familiarity with binocular otoscopy among pediatric and general medicine professors in physician training programs is probably a more difficult obstacle to overcome. Thus, the standard of general otologic diagnosis and ear care remains, for the most part, the largely antiquated monocular otoscope.


Selected patents

* , "''Speculum ''", Willard E Dow, 1901. * , "''Otoscope ''", Henry L De Zeng, 1926. * , "''Otoscope ''", Henry L De Zeng, 1927. * , "''Otoscope ''", John G Smith, 1928. * , "''Otoscope ''", Arthur F Dittmer, 1939. * , "''Otoscope construction ''", William C. Moore, John D. Connors, Richard W. Newman, 1977. * , "''Combination otoscope and audiometer ''", James W. Heller, 1986.


See also

*
Intraoral camera {{Unreferenced, date=June 2015 Intraoral cameras (IOCs) are cameras used by dentists or doctors to show a patient the interior of their mouth, as an alternative to using a mirror. They were first introduced in 1989 and are now widely used in denta ...


References


External links


Phisick
– Pictures and information about antique otoscopes {{Endoscopy Ear procedures Medical equipment