Use of the Otoscope in Athletic Training. Objectives Briefly discuss the types and features of the...

Use of the Otoscope in Use of the Otoscope in Athletic TrainingAthletic Training

Objectives

Briefly discuss the types and features of the Briefly discuss the types and features of the otoscopeotoscope

Provide an overview of otoscopic assessment Provide an overview of otoscopic assessment proceduresprocedures

Present a clinical teaching model for teaching Present a clinical teaching model for teaching your students to properly use the otoscopeyour students to properly use the otoscope

Provide educational resources for teaching Provide educational resources for teaching otoscopyotoscopy

Briefly discuss the types and features of the Briefly discuss the types and features of the otoscopeotoscope

Provide an overview of otoscopic assessment Provide an overview of otoscopic assessment proceduresprocedures

Present a clinical teaching model for teaching Present a clinical teaching model for teaching your students to properly use the otoscopeyour students to properly use the otoscope

Provide educational resources for teaching Provide educational resources for teaching otoscopyotoscopy

Types & Features of the OtoscopeTypes & Features of the Otoscope

Types of Otoscopes

Pocket stylePocket style < $50< $50

Pocket stylePocket style < $50< $50

Pocket stylePocket style

Clinical modelClinical model

Clinical modelClinical model $200 - $400+$200 - $400+

Clinical modelClinical model $200 - $400+$200 - $400+

Features of the Otoscope

Power sourcePower source Battery (most common in Battery (most common in

athletic training clinical athletic training clinical setting)setting)

Electric Electric

Power sourcePower source Battery (most common in Battery (most common in

athletic training clinical athletic training clinical setting)setting)

Electric Electric Light sourceLight source

Incandescent bulb (produces a Incandescent bulb (produces a yellow light)yellow light)

Hallogen bulb (Hallogen bulb (bestbest – – produces a white light)produces a white light)

Light sourceLight source Incandescent bulb (produces a Incandescent bulb (produces a

yellow light)yellow light) Hallogen bulb (Hallogen bulb (bestbest – –

produces a white light)produces a white light)


MagnifierMagnifier Not available on all modelsNot available on all models Provides better view of Provides better view of

tympanic membrane, tympanic membrane, particularly for beginners particularly for beginners

MagnifierMagnifier Not available on all modelsNot available on all models Provides better view of Provides better view of

tympanic membrane, tympanic membrane, particularly for beginners particularly for beginners


SpeculumSpeculum Variety of sizesVariety of sizes Reusable or disposableReusable or disposable

SpeculumSpeculum Variety of sizesVariety of sizes Reusable or disposableReusable or disposable

Overview of Otoscopic Overview of Otoscopic AssessmentAssessment

Examination of the EarExamination of the Ear

HHistoryistoryOObservationbservationPPalpationalpation

HHistoryistoryOObservationbservationPPalpationalpationSSpecialpecial teststests

Otoscopic assessmentOtoscopic assessment

SSpecialpecial teststests Otoscopic assessmentOtoscopic assessment

Examination of the EarExamination of the Ear

HistoryHistoryHistoryHistory TraumaTrauma Allergies, colds, sinus drainageAllergies, colds, sinus drainage Changes in pressure (flying, diving)Changes in pressure (flying, diving) DizzinessDizziness Changes in hearingChanges in hearing Duration of symptomsDuration of symptoms

TraumaTrauma Allergies, colds, sinus drainageAllergies, colds, sinus drainage Changes in pressure (flying, diving)Changes in pressure (flying, diving) DizzinessDizziness Changes in hearingChanges in hearing Duration of symptomsDuration of symptoms

Examination of the Ear

ObservationObservationObservationObservation RednessRedness SwellingSwelling DrainageDrainage Foreign objectForeign object Cuts, scrapes, Cuts, scrapes,

bruisesbruises

RednessRedness SwellingSwelling DrainageDrainage Foreign objectForeign object Cuts, scrapes, Cuts, scrapes,

bruisesbruises


PalpationPalpationPalpationPalpation Gentle pressure Gentle pressure

on traguson tragus

Gentle pressure Gentle pressure on traguson tragus


PalpationPalpationPalpationPalpation Traction on ear lobe & Traction on ear lobe &

pinnapinna

Traction on ear lobe & Traction on ear lobe & pinnapinna

Otoscopic Assessment

Evaluate the Evaluate the noninvolved ear firstnoninvolved ear first

Evaluate the Evaluate the noninvolved ear firstnoninvolved ear first

This practice provides This practice provides a basis for comparison a basis for comparison ANDAND prevents cross- prevents cross-contaminationcontamination

This practice provides This practice provides a basis for comparison a basis for comparison ANDAND prevents cross- prevents cross-contaminationcontamination


Step 1:Step 1:Step 1:Step 1: Place your patient in a Place your patient in a

seated position with seated position with his/her head turned his/her head turned slightly downward and slightly downward and away from the ear to be away from the ear to be examinedexamined

Place your patient in a Place your patient in a seated position with seated position with his/her head turned his/her head turned slightly downward and slightly downward and away from the ear to be away from the ear to be examinedexamined


Step 1 (cont.):Step 1 (cont.):Step 1 (cont.):Step 1 (cont.): I teach this as the I teach this as the

“puppy position” “puppy position” (puppies always cock (puppies always cock their heads to the side their heads to the side when you talk to them)when you talk to them)

I teach this as the I teach this as the “puppy position” “puppy position” (puppies always cock (puppies always cock their heads to the side their heads to the side when you talk to them)when you talk to them)


Step 2:Step 2:Step 2:Step 2: Select the largest Select the largest

possible speculum possible speculum that can be that can be comfortably inserted comfortably inserted into the earinto the ear

Select the largest Select the largest possible speculum possible speculum that can be that can be comfortably inserted comfortably inserted into the earinto the ear


Step 2 (cont.):Step 2 (cont.):Step 2 (cont.):Step 2 (cont.): When inserted, the When inserted, the

speculum should fit speculum should fit snugly in the outer snugly in the outer third of the canal third of the canal and rest against the and rest against the tragustragus and anterior and anterior wall of the canalwall of the canal

When inserted, the When inserted, the speculum should fit speculum should fit snugly in the outer snugly in the outer third of the canal third of the canal and rest against the and rest against the tragustragus and anterior and anterior wall of the canalwall of the canal

Modified from Middle Ear Conditions. Anatomical Chart Co. Skokie, IL, 1999.


Step 2 (cont.):Step 2 (cont.):Step 2 (cont.):Step 2 (cont.): Choosing a Choosing a

speculum that is too speculum that is too small will cause small will cause movement within movement within the canal the canal

Excessive Excessive movement can cause movement can cause discomfort for your discomfort for your patientpatient

Choosing a Choosing a speculum that is too speculum that is too small will cause small will cause movement within movement within the canal the canal

Excessive Excessive movement can cause movement can cause discomfort for your discomfort for your patientpatient



Step 3:Step 3:Step 3:Step 3: Hold the otoscope Hold the otoscope

with the same hand as with the same hand as the ear you are the ear you are examining examining right ear, right handright ear, right handleft ear, left handleft ear, left hand

Hold the otoscope Hold the otoscope with the same hand as with the same hand as the ear you are the ear you are examining examining right ear, right handright ear, right handleft ear, left handleft ear, left hand


Step 3 (cont.):Step 3 (cont.):Step 3 (cont.):Step 3 (cont.): The otoscope should The otoscope should

be stabilized by be stabilized by placing the ring and placing the ring and little finger resting on little finger resting on the patient’s cheek or the patient’s cheek or templetemple

The otoscope should The otoscope should be stabilized by be stabilized by placing the ring and placing the ring and little finger resting on little finger resting on the patient’s cheek or the patient’s cheek or templetemple


Pencil GripPencil Grip Hammer GripHammer Grip


Step 4:Step 4:Step 4:Step 4: Pull the pinna Pull the pinna

upward and upward and backward to backward to straighten the straighten the canalcanal

Pull the pinna Pull the pinna upward and upward and backward to backward to straighten the straighten the canalcanal



Step 5:Step 5:Step 5:Step 5: While maintaining While maintaining

traction on the pinna, traction on the pinna, place the speculum place the speculum of the otoscope of the otoscope at, at, but not inbut not in the ear the ear canalcanal

While maintaining While maintaining traction on the pinna, traction on the pinna, place the speculum place the speculum of the otoscope of the otoscope at, at, but not inbut not in the ear the ear canalcanal


Caution:Caution:Caution:Caution: Never insert Never insert

the otoscope the otoscope blindlyblindly

AlwaysAlways“Watch your“Watch your way in” way in”

Never insert Never insert the otoscope the otoscope blindlyblindly

AlwaysAlways“Watch your“Watch your way in” way in”


Tip:Tip:Tip:Tip: If the patient If the patient

experiences pain, experiences pain, reposition the reposition the canal by canal by adjusting the adjusting the angle and degree angle and degree of traction on the of traction on the pinnapinna

If the patient If the patient experiences pain, experiences pain, reposition the reposition the canal by canal by adjusting the adjusting the angle and degree angle and degree of traction on the of traction on the pinnapinna


Caution:Caution:Caution:Caution: If the patient’s If the patient’s

discomfort persists discomfort persists even after even after readjustment of the readjustment of the canal, halt the canal, halt the examination and examination and refer the patient to a refer the patient to a physician.physician.

If the patient’s If the patient’s discomfort persists discomfort persists even after even after readjustment of the readjustment of the canal, halt the canal, halt the examination and examination and refer the patient to a refer the patient to a physician.physician.


Step 6:Step 6:Step 6:Step 6: Once the tympanic Once the tympanic

membrane comes into membrane comes into view, rotate the view, rotate the speculum to view as speculum to view as much of the membrane much of the membrane as possibleas possible

Once the tympanic Once the tympanic membrane comes into membrane comes into view, rotate the view, rotate the speculum to view as speculum to view as much of the membrane much of the membrane as possibleas possible

Posterior superiorPosterior superior Anterior superiorAnterior superior Anterior inferiorAnterior inferior Posterior inferiorPosterior inferior

Posterior superiorPosterior superior Anterior superiorAnterior superior Anterior inferiorAnterior inferior Posterior inferiorPosterior inferior

Marty DR. The Ear Book. Jefferson City, MO: Lang ENT Publishing. 1987;Color plate 1.


Like trying to Like trying to view the corners view the corners of a room through of a room through a key holea key hole

Like trying to Like trying to view the corners view the corners of a room through of a room through a key holea key hole

TipTipTipTip

Marty DR. The Ear Book. Jefferson City, MO: Lang ENT Publishing. 1987;Color plate 1.


This is due to the angle of the This is due to the angle of the membrane within the canalmembrane within the canal


TipTipTipTip The posterior The posterior

inferior portion of inferior portion of the membrane is the membrane is often difficult to often difficult to seesee

The posterior The posterior inferior portion of inferior portion of the membrane is the membrane is often difficult to often difficult to seesee

Fincher AL. Use of the otoscope in the evaluation of common injuries and illnesses of the ear. J Athl Train. 1994;29:53,54.



Step 7:Step 7: Step 7:Step 7:

LR

Inspect the membrane for Inspect the membrane for color, clarity, & position color, clarity, & position Pearly grayPearly graySemitransparentSemitransparentNot bulging or retractedNot bulging or retracted

Inspect the membrane for Inspect the membrane for color, clarity, & position color, clarity, & position Pearly grayPearly graySemitransparentSemitransparentNot bulging or retractedNot bulging or retracted



Step 8:Step 8: Identify key landmarksIdentify key landmarks

Step 8:Step 8: Identify key landmarksIdentify key landmarks

LR

UmboUmbo

Short Short processprocessMalleusMalleusMalleusMalleus

• ManubriumManubrium• Short process Short process • UmboUmbo

• ManubriumManubrium• Short process Short process • UmboUmbo

Light reflexLight reflexLight reflexLight reflex



Step 8 (cont.):Step 8 (cont.): Identify key landmarksIdentify key landmarks


LR

Note that manubrium Note that manubrium angles toward the 10:00 angles toward the 10:00 position in the left ear position in the left ear and the 2:00 position in and the 2:00 position in the right earthe right ear

Note that manubrium Note that manubrium angles toward the 10:00 angles toward the 10:00 position in the left ear position in the left ear and the 2:00 position in and the 2:00 position in the right earthe right ear





LR

Pars tensaPars tensa

Pars flaccidaPars flaccidaPars flaccidaPars flaccidaPars tensaPars tensaPars tensaPars tensaAnnulusAnnulusAnnulusAnnulus

Pars flaccidaPars flaccida



Step 8 (cont.):Step 8 (cont.): Step 8 (cont.):Step 8 (cont.): Identify key landmarksIdentify key landmarks

Look beyond the membraneLook beyond the membrane

• StapesStapes

• IncusIncus

Identify key landmarksIdentify key landmarksLook beyond the membraneLook beyond the membrane

• StapesStapes

• IncusIncus

Fincher AL. Use of the otoscope in the evaluation of common injuries and illnesses of the ear. J Athl Train. 1994;29:53.


Step 9:Step 9: Look for abnormalitiesLook for abnormalities

FluidFluidPerforationsPerforations

Step 9:Step 9: Look for abnormalitiesLook for abnormalities

FluidFluidPerforationsPerforations

PerforationMarty DR. The Ear Book. Jefferson City, MO: Lang ENT Publishing. 1987;Color plate 8.

Fluid & Air BubblesFincher AL. Use of the otoscope in the evaluation of common injuries andillnesses of the ear. J Athl Train. 1994;29:54.


Step 10Step 10Step 10Step 10 Work with your team physician to Work with your team physician to

develop your confidence and skilldevelop your confidence and skill

Work with your team physician to Work with your team physician to develop your confidence and skilldevelop your confidence and skill

PRACTICE, PRACTICE, PRACTICE !!!PRACTICE, PRACTICE, PRACTICE !!! You must look at many ears to develop to You must look at many ears to develop to

become comfortable with “normal”become comfortable with “normal”

PRACTICE, PRACTICE, PRACTICE !!!PRACTICE, PRACTICE, PRACTICE !!! You must look at many ears to develop to You must look at many ears to develop to

become comfortable with “normal”become comfortable with “normal”

Guided, Self-Directed Activities – Post LabContentContent

Recognition of pathology – visual imagesRecognition of pathology – visual images

ContentContent Recognition of pathology – visual imagesRecognition of pathology – visual images

PerforationMarty DR. The Ear Book. Jefferson City, MO: Lang ENT Publishing. 1987;Color plate 8.

Middle ear fluidMarty DR. The Ear Book. Jefferson City, MO: Lang ENT Publishing. 1987;Color plate 3.

Guided, Self-Directed Activities – Post LabContentContent

Recognition of pathology – visual imagesRecognition of pathology – visual images

ContentContent Recognition of pathology – visual imagesRecognition of pathology – visual images

PerforationModified from Middle Ear Conditions. Anatomical Chart Co., Skokie, IL. 1999.

Otitis MediaModified from Middle Ear Conditions. Anatomical Chart Co., Skokie, IL. 1999.

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