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 ...

used by healthcare professionals to examine 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 auricle to the eardrum and is about in length and in diameter. S ...

and

eardrum 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 changes in pres ...

. This may be done as part of routine physical examinations, or for evaluating specific ear complaints, such as earaches, sense of fullness in the ear, or

hearing loss Hearing loss is a partial or total inability to hear. Hearing loss may be present at birth or acquired at any time afterwards. Hearing loss may occur in one or both ears. In children, hearing problems can affect the ability to acquire spo ...

Usage

Function

An otoscope enables viewing and examination of the

and

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 changes in pressur ...

(eardrum). Otoscopic examination can help diagnose conditions such as acute

otitis media Otitis media is a group of Inflammation, 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 pullin ...

(infection of the middle ear), traumatic perforation of the eardrum, and

cholesteatoma Cholesteatoma is a destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process. Cholesteatomas are not cancerous as the name may suggest, but can cause significant problems because of the ...

. The presence of

cerumen Earwax, also known by the medical term cerumen, is a waxy substance secreted in the ear canal of humans and other mammals. Earwax can be many colors, including brown, orange, red, yellowish, and gray. Earwax protects the skin of the human ear c ...

(earwax), shed skin, pus, canal skin

edema Edema (American English), also spelled oedema (British English), and also known as fluid retention, swelling, dropsy and hydropsy, is the build-up of fluid in the body's tissue (biology), tissue. Most commonly, the legs or arms are affected. S ...

, foreign bodies, and various ear diseases, can obscure the view of the eardrum and thus compromise the value of otoscopy done with a common otoscope, but can confirm the presence of obstructing symptoms. Otoscopes can also be used to examine patients' noses (avoiding the need for a separate nasal speculum) and upper throats (by removing the speculum).

Method of use

The most common otoscopes consist of a handle and a head. The head contains a light source and a magnifying lens, to help illuminate and enlarge ear structures. The

distal Standard anatomical terms of location are used to describe unambiguously the anatomy of humans and other animals. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position provi ...

(front) end of the otoscope has an attachment for disposable plastic ear specula. The examiner first pulls on the pinna (usually the earlobe, side or top) to straighten the ear canal, and then inserts the ear speculum side of the otoscope into the outer ear. It is important to brace the index or little finger of the hand holding the otoscope against the patient's head to avoid injuring the ear canal. The examiner then looks through the lens on the rear of the instrument to see inside the ear canal. In many models, the examiner can remove the lens and insert instruments like specialized suction tips through the otoscope into the ear canal, such as for removing earwax. Most models also have an insertion point for a bulb that pushes air through the speculum ( pneumatic otoscopy) for testing eardrum mobility.

Types

Many otoscopes for doctors' offices are wall-mounted, with an electrical cord providing power from an electric outlet. Portable otoscopes powered by batteries (usually rechargeable) in the handle are also available. 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.

Monocular and binocular

Most otoscopes used in emergency rooms, pediatric offices,

general practice General practice is personal, family, and community-orientated comprehensive primary care that includes diagnosis, continues over time and is anticipatory as well as responsive. Definitions A general practitioner (GP) is a doctor who is a consu ...

, and by internists are monocular devices. These provide a two-dimensional view of the ear canal and its contents, and usually at least a portion of the eardrum. Another method of performing otoscopy (visualization of the ear) is by using a binocular (two-eyed) microscope in conjunction with a larger plastic or metal ear speculum, which provides a much larger field of view. The microscope is suspended from a stand, which frees up both of the examiner's hands; the patient is placed in a

supine position The supine position () means lying horizontally, with the face and torso facing up, as opposed to the prone position, which is face down. When used in surgical procedures, it grants access to the peritoneal, thoracic, and pericardium, pericardial ...

and their head is tilted, which keeps the head stable and enables better lighting. The binocular view enables depth perception, which makes removal of earwax or other obstructing materials easier and less hazardous. The microscope also has up to 40× magnification, allowing more detailed viewing of the entire ear canal, and of the entire eardrum (unless prevented by

of the canal skin). Subtle changes in the anatomy can also be more easily detected and interpreted. Traditionally, binocular microscopes are only used by otolaryngologists (ear, nose, and throat specialists) and otologists (subspecialty ear doctors). Their widespread adoption in general medicine is hindered by cost and lack of familiarity among pediatric and general medicine professors in physician training programs. 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.

Pneumatic otoscope

The pneumatic otoscope is used to examine the

for assessing the health of the

middle ear The middle ear is the portion of the ear medial to the eardrum, and distal to the oval window of the cochlea (of the inner ear). The mammalian middle ear contains three ossicles (malleus, incus, and stapes), which transfer the vibrations ...

. This is done by assessing the eardrum's contour (normal, retracted, full, or bulging), its color (gray, yellow, pink, amber, white, red, or blue), its translucency (translucent, semi-opaque, opaque), and its mobility (normal, increased, decreased, or absent). The pneumatic otoscope is the standard tool used in diagnosing

(infection of the middle ear). The pneumatic otoscope has a pneumatic (diagnostic) head, which contains a lens, an enclosed light source, and a nipple for attaching a rubber bulb and tubing. By gently squeezing and releasing the bulb in rapid succession, the degree of eardrum mobility in response to positive and negative pressure can be observed. The head is designed so that an airtight chamber is produced when a speculum is attached and fitted snugly into the patient's

. Using a rubber-tipped speculum or adding a small sleeve of rubber tubing at the end of a plastic speculum, can help improve the airtight seal and also help avoid injuring the patient. By replacing the pneumatic head with a surgical head, the pneumatic otoscope can also be used to clear

earwax Earwax, also known by the medical term cerumen, is a waxy substance secreted in the ear canal of humans and other mammals. Earwax can be many colors, including brown, orange, red, yellowish, and gray. Earwax protects the skin of the human ear ...

from the ear canal, and to perform diagnostic

tympanocentesis Tympanocentesis is the drainage of fluid from the middle ear, usually caused by otitis media, by using a small-gauge needle to puncture the tympanic membrane (eardrum). It is indicated in children with acute otitis media who are susceptible to c ...

(drainage of fluid from the middle ear) or

myringotomy A myringotomy is a surgical procedure in which an incision is created in the eardrum (tympanic membrane) to relieve pressure caused by excessive buildup of fluid, or to drain pus from the middle ear. A tympanostomy tube may be inserted through th ...

(creation of incision in the eardrum). The surgical head consists of an unenclosed light source and a lens that can swivel over a wide arc.

References

External links

* – Pictures and information about antique otoscopes {{Endoscopy Ear procedures Endoscopes Medical equipment French inventions