How to perform perfect otoscopy ?

From Otolaryngology Online

Otoscopy is a procedure by which the external auditory canal and the ear drum of a patient is examined. The art of doing a perfect otoscopic examination lies in straightening the external auditory canal in order to visualize the ear drum in toto.

The following equipments are used in this procedure:

1. Otoscope

2. Aural speculum if otoscope is not available

3. Otoendoscope


is a procedure where in the ear drum can be examined using an otoscope. The role of the speculum in the otoscope is to straighten the external canal and make the ear drum visible. If this procedure is not performed in a systematic way the findings are likely to be missed.

Step I: Optimal size of the ear speculum should be selected. This is important because a narrow speculum limits the visible zone of the ear canal and ear drum causing the examiner to make errors.

Step II: The first structure to be visualised / sought for is the handle of the malleus since it is the most prominent portion of the ear drum.

Step III: The scope is now tilted superiorly bringing into view the lateral process of the malleus. The attic portion of the ear drum comes into view now.

Step IV: The scope is tilted now anteriorly to examine the anterior portion of the ear drum

Step V: The scope is tilted inferiorly to view the hypotympanic portion of the ear drum

Step VI: Now the postero lateral wall of the external canal is examined by tilting the speculum.

Step VII : Siegelisation of the ear drum is performed to test its mobility.