Examination of the ear

Question 1

In clinical practice, which ear is examined first?

Answer 1

The ear least likely to have pathology

Question 2

How does examination of the ear begin?

Answer 2

Inspection and palpation of the skin adjacent to the pinna and the pinna itself

Pinna is inspected for size, position and shape
Palpated for tenderness, swellings or nodules

Question 3

What might indicate an external ear infection on examination of the ear?

Answer 3

1. Pain on pulling up or down on the pinna or by pressing on the tragus

Question 4

How is the external ear assessed?

Answer 4

Inspected for deformities, nodules, inflammation, lesions and discharge (color, consistency, smell and clarity)

Question 5

How is the posterior auricular region assessed?

Answer 5

Inspected for scars and swelling

Question 6

What might indicate mastoiditis on examination of the ear?

Answer 6

Pain when pressure is applied on the mastoid tip

Question 7

How should an otoscopic examination be performed in an adult and in children?

Answer 7

To straighten the ear canal..
Adult: begin by pulling the pinna up, out and back with opposite hand holding the otoscope
Children: pull pinna down and back

Ask patient to turn head to the side

Question 8

What is indicative of inflammation in the ear canal during an otoscopic examination?

Answer 8

Redness, swelling or tenderness

Question 9

How should the tympanic membrane appear on otoscopic examination and which structures should be able to be visualized?

Answer 9

Intact, translucent, pearly grey membrane.

• Blood vessels should be visible around the membrane perimeter
• The handle of the malleus should be seen near the centre of the tympanic membrane

Question 10

Which margin of the tympanic membrane is closer to the examiner’s eye?

Answer 10

The tympanic membrane is oblique to the external canal, so the superior margin is closer to the examiner’s eye

Question 11

What would a sharp outline of the malleus indicate and why might this occur?

Answer 11

A retracted tympanic membrane; may occur when middle ear pressures are reduced due to, for example, obstruction of the eustachian tube

Question 12

How does the tympanic membrane appear when there is disease present?

Answer 12

May be dull and becomes red or yellow

Blood vessels may be dilated; implying infection or inflammation

Question 13

What might indicate fluid or pus in the middle ear?

Answer 13

Bulging of the tympanic membrane

Question 14

What is tympanosclerosis and what might it visually cause?

Answer 14

Scarring of the tympanic membrane, (typically post injury or surgery) may cause dense, white plaques to form on it

Question 15

What should NOT be seen behind the tympanic membrane?

Answer 15

Bubbles or fluid

Question 16

What is the light reflex of the ear and when is it observed?

Answer 16

A visible phenomenon which occurs upon examination of the tympanic membrane with an otoscope.

Shining light on the tympanic membrane causes a cone-shaped reflection of light to appear in the anterior inferior quadrant

Question 17

What is an ear examination completed with? If poor, what management does it indicate the need for?

Answer 17

Assessment of auditory acuity (clarity of hearing) to identify whether they need a hearing aid

Question 18

How is the range and sensitivity of a person’s sense of hearing tested?

Answer 18

Audiometry; threshold for hearing a range of pure tones is tested and compared to a normal response