Generality
Otoscopy is an objective examination of the ear, which allows inspection of the external auditory canal and the tympanic membrane; in this way, the doctor can identify the presence of foreign bodies and / or pathological conditions that can cause various disorders, such as, for example, ear pain, hearing loss or deafness.
otoscope
As mentioned, otoscopy is performed using an instrument called an otoscope.
There are several types of otoscopes that can be used to conduct the aforementioned objective examination of the ear. However, the most widespread is, most likely, the battery-powered otoscope .
The battery-powered otoscope is an optical instrument whose shape can remind you of a hammer. It consists of a base, or handle, which can be made of plastic or metal, and a head with which the actual examination is performed.
The otoscope head has a cone shape; in it there is a luminous protrusion that directs the light beam inside the ear and a magnifying glass made of optical glass that allows an enlarged view (usually 3x) of the ear canal and the eardrum.
At the end of the cone that constitutes the head of the otoscope - before the examination is performed - an ear speculum of plastic and conical shape is inserted. Usually, the speculum in question is disposable and must have dimensions appropriate to the size of the patient's auditory canal on which it is necessary to perform the examination (the ear speculums used in children, therefore, will be smaller than those used for adults).
How to perform Otoscopy
Before proceeding with otoscopy, the doctor must first exercise upward and backward traction on the auricle, so as to "straighten" the auditory canal as much as possible, which in itself tends to be curved and do not allow adequate vision of the external ear and the tympanic membrane.
After performing this simple maneuver, the doctor can insert the otoscope into the patient's ear and proceed with the examination.
During otoscopy, the doctor usually supports the forefinger, or even the whole hand that holds the otoscope to the patient's head, in order to be more stable and to avoid possible accidental lesions of the ear canal due, in fact, to possible instability in the socket of the instrument.
What is observed with the Otoscope
Through the use of the otoscope, the doctor (general or specialist) is able to inspect the external ear - therefore the ear canal - and the tympanic membrane of the patients. More in detail, thanks to the use of this particular optical instrument, the doctor can identify the presence of:
- Abnormalities and / or malformations of the ear canal or tympanic membrane;
- Inflammations and / or pathologies of the external ear and / or middle ear (otitis, mycosis, etc.);
- Ear-plugs and foreign bodies of various kinds.
The otoscope also allows the tympanic membrane to be examined, allowing the evaluation of parameters that characterize it, such as:
- Color;
- Position;
- Mobility;
- Brightness;
- Translucency.
In addition to this, thanks to the otoscopic examination it is also possible to identify the presence of any endotympanic effusions.
Micro-otoscopy
Micro-otoscopy is an objective examination of the ear exactly like otoscopy, but differs from the latter because - instead of being performed with a normal battery-powered otoscope - it is performed through the use of a binocular microscope .
This instrument - characterized by the presence of a coaxial illumination - allows to perform a micro-otoscopic examination, allowing a vision of the external ear and the middle ear decidedly more enlarged (10x or 20x) than that obtained by means of the use of the most classic battery-powered otoscope. Furthermore, thanks to the binocular microscope it is also possible to perform - on an outpatient basis, as well as in the operating room - small surgical procedures.
Operations and surgical interventions
Through otoscopy - as well as performing an analysis of the external and middle ear - it is also possible to perform some simple operations or minor surgical procedures. The simplest operations can be performed in the outpatient setting by the otolaryngologist, with the use of the battery-powered otoscope and any other instruments; the most complex surgical interventions, instead, are performed in the operating room and, generally, with the aid of the binocular microscope.
However, the main operations and small surgical procedures that can be performed by otoscopy are:
- Removal of earwax stoppers and foreign bodies of various kinds (this operation can be performed using the battery-powered otoscope, inserting a special instrument on the head to remove the body that causes obstruction of the ear canal);
- Excision of small polyps from the ear canal;
- Tympanocentesis, ie the execution of a small incision on the tympanic membrane in order to evacuate or withdraw pus (used above all in the case of purulent otitis);
- Transtympanic drainage (carried out especially in cases of serous otitis).
Pneumatic otoscopy
Pneumatic otoscopy is an ear test that is performed in a pediatric setting mostly to diagnose acute otitis media, to assess progression and healing and to assess the presence and possible persistence of endotympanic exudate.
This examination is carried out with the use of a particular instrument - the pneumatic otoscope - and allows performing a more in-depth analysis of the tympanic membrane than that which can be performed with simple otoscopy.
The pneumatic otoscope, in fact, is equipped with a connector on which a ball insufflator is positioned which - through the speculum - allows the injection of air into the ear to assess the mobility of the tympanic membrane.
Under normal conditions, the tympanic membrane moves freely under the influence of the air jet that is pushed into the ear, while in pathological conditions there is an alteration of the movement of the same membrane. This alteration can manifest itself, for example, as a reduction of the mobility of the membrane to the compression and the release of the insufflator, or as a more accentuated mobility to the release of the insufflator rather than to the compression of the same.
Pneumatic otoscopy, therefore, is able to provide more detailed information than the classic otoscopy, thus making it possible to define more accurately the pathologies of the middle ear in pediatric age.
