• • Examination of the tympanic membranes and ear canals is part of routine health maintenance.

  • Tympanic membranes should also be visualized with complaint of ear pain, upper respiratory tract infection, or fever.

  • Serial examinations are indicated over several months to check for resolution of effusion.

  • A complaint of hearing loss should also prompt a careful otoscopic examination.

Relative

• • In the presence of otitis externa, the tympanic membrane will be difficult to visualize because of occlusion with pus.

  • Presence of cerumen in the canal may require removal with a curette or irrigation in the office or alternatively use of a cerumen-reducing agent at home with return for reexamination in a few days.

• • Otoscope with insufflator attachment.

  • Ear curettes.

  • Hydrogen peroxide diluted 1:1 with lukewarm water.

• • If an uncooperative child is not held completely still, there is a risk of laceration to the ear canal.

• • While most offices have disposable tips for the otoscope, use of the tips supplied by the manufacturer tend to have a better fit and yield more accurate results on pneumatic otoscopy.

  • A 10-mL syringe with a cut-off angiocatheter plastic tip is useful for instillation of dilute hydrogen peroxide when irrigation is required.

• • Warn the patient that a pressure sensation and possibly pain will be experienced when using the insufflator.