Introduction to Otoscopy
Otoscopy, an integral part of every doctor’s routine physical examination, is a medical procedure that involves taking a look into our ears and down our ear canals using an instrument called an otoscope. The purpose of otoscopy is to examine whether the different parts of the ear, which include the pinna, the external and internal auditory canal, and the eardrum, are all in good condition. Looking into the state of these structures can spell the difference between ignorance and prevention of some serious medical illnesses associated with hearing loss. Aside from general check-up procedures and routine screening, otoscopy is also done during extensive hearing assessments, before taking an impression of the ear for hearing aid fitting, and in the assessment of hearing aids. Usually sold in sets with ophthalmoscopes, otoscopes are standard tools in every doctor’s arsenal.
The otoscope as a tool began in the mid-1300s in France, used to study the aural and nasal passages. During the 19th century, many other otoscope varieties arose, all serving the same, original purpose. The funnel-shaped speculum, which is how the modern otoscope looks like today, was invented in 1838, and the pneumatic otoscope was invented in 1864, used to observe how the tympanic membrane reacts to air pressure. The binocular otoscope, meanwhile introduced for surgical use, was invented in 1872 and revolutionized ear surgery for its time. Today, because of the tool’s versatility, the modern otoscope can also be used to observe the nasal passages of patients, as well as the upper throat and the oral cavity. What used to be a simple tool addressing the cause of ear pain in patients has now evolved into the sophisticated instrument that serves a variety of uses in the medical setting today.
Guide to Parts
Though seemingly a complex instrument, the key concept upon which the otoscope operates is simple–it is a tool that provides a concentrated source of illumination with magnification incorporated in the easy-to-hold structural design. Otoscopes usually consist of three primary parts–the handle, the head, and the cone. The handle is where the power source is located, either in the form of an electrical component to be plugged into a wall socket, or an enclosure for batteries. The head of the otoscope includes the most important component of the instrument, the manual focus halogen or incandescent bulb, with an easily adjustable intensity of light. The head of the otoscope is also where the eyepiece is located. Meanwhile, the cone part of the otoscope’s head is appropriately shaped to fit inside a patient’s ear, as well as the nose and throat. This particular part of the instrument is designed to be fitted with speculae or ear tips, which are separate, detachable components of the otoscope usually made of plastic and disposable material. Shaped like a cone with holes at both ends, the speculum goes on top of the head of the otoscope and is used to focus the light onto the ear canal. Specula are produced in various diameters and lengths to fit different patients’ ear sizes, permitting safe and sanitary visualization of the inner ear. It is recommended that the largest possible size of the speculum is used to allow for the most amount of light to enter the patient’s ear canal. Common sizes for disposable speculums are 2 mm for infants, and, 3 mm, 4 mm, and 5 mm for adults.
The head of the otoscope is also equipped with a hole for an insufflator, another separate piece that provides a small air vent connection that lets the doctor to puff air into the ear canal. This technique, called insufflation or pneumatic otoscopy, allows the doctor to assess the mobility of the eardrum by observing how it responds to varying levels of air pressure.
How It’s Used
A complete assessment of the ear requires a systematic examination of its external and internal structures. The first step to the otoscopic examination is the preparation of tools and procedures using hygienic and sanitary methods. Next, since otoscopy as a procedure is one that may cause discomfort or pain to the patient due to a very close proximity with the doctor as well as the naturally uncomfortable process of having a foreign object stuck into one’s ear, it is important to establish proper informed consent before the examination can begin, as with any medical procedure. It can be of large assistance to inform the patient beforehand as to what shall happen during the examination, and what they must keep in mind. Such reminders include sitting still and speaking up if it gets too uncomfortable for the patient. It must also be noted that this preliminary step is especially important when dealing with children and babies because the risk for complications in the procedure could be high. When dealing with younger patients, it is better to proceed with the examination because any preliminary information might scare them or make them refuse to cooperate. It is better to work with a parent or primary caregiver in keeping them steady for the procedure.
Ask the client to tilt their head slightly while seated. The first thing to be examined is the outer ear, with careful observation of the auricle, pinna, and surrounding areas for any abnormalities such as skin lesions, tenderness, foul odor, and tilt of the ears. For instance, the ear position of a child is normally at a 10-degree tilt, and positions outside of this range could be a clinical marker for serious medical conditions associated with hearing loss. Any tenderness or pain that the patient could experience during this preliminary inspection could be a sign not to go through with the otoscopy and should, therefore, be noted accordingly.
After the external visual inspection is done, the internal structures are examined using the otoscope. First, equip the otoscope with the properly-sized speculum, preferably the largest. For adults, it is generally recommended to use speculum of 4-6 mm in size. Turn the device on and hold it delicately, as if you are holding a pen. When examining the right ear of the patient, use your right hand. Balance the otoscope lightly between thumb and index finger, and extend your pinky and rest it against the patient’s face to track movement. This is so that if the patient suddenly moves, you may follow with your hand and otoscope to avoid any accidental harm or injury. During the procedure, the pinna must be pulled gently upwards, outwards, and backward to straighten the auditory canal. Finally, insert the otoscope into the external auditory meatus, look through the view piece, and inspect the tympanic membrane or the eardrum. In general inspection procedures, it is useful to take note of the 4Ds, namely, discharge, displacement, discoloration, and deformity. After examining the first ear, repeat the whole process with the other ear and proceed to do some other hearing tests to complete the ear examination.
Examining the Structures
Abnormal findings from observations of the outer ear and external auditory canal may include flaky linings and symptoms of itchiness suggestive of eczema, or a swollen auditory canal with discharge often accompanied by an unpleasant smell, suggestive of infection. Take note of the normal structures that must be seen in the tympanic membrane during the otoscopic procedure. In addition to identifying these structures, other contents of the inner ear such as foreign bodies or wax must also be noted.
Selection Criteria for Choosing the Right Otoscope
Primary care physicians require the use of otoscopes for screening illnesses and looking closely at symptoms of the ear, and it is, therefore, an indispensable instrument in the medical field. Specialty instruments such as these are often sold for high prices in the market, and for a good reason–as healthcare practitioners, the service one provides should not be compromised by tools of low quality. Thus, here are some important selection criteria one should keep in mind when choosing what otoscope to purchase.
In selecting the best otoscope in the market, the first thing to decide is one’s budget. Otoscopes are no cheap tools, and it should, therefore, be one’s goal to look for a compromise between quality and cost. The performance of otoscopes meanwhile must be judged regarding light source technology and strength of magnification, both very important features of an effective instrument for patient examination. Next, as these tools must ideally be designed for repeated use, the comfort of both patient and user should be factored in its structural design. How easy is it to use? How comfortable is it for the patient? These are questions that must be answered sufficiently to make a confident otoscope purchase. Finally, another important feature of otoscopes is how long they will last. In buying an instrument as expensive as these specialty tools, one must look into the product’s lifespan and available warranty from the brand.
Now that we’ve listed all there is to think about, let’s look at the best otoscopes in the market today. Though there are many different types of otoscopes such as pocket, full-size, and video otoscopes, this list shall cover all types and identify which ones are the best-recommended purchases.
- Needs and Price
- Over-engineered but certainly not overpriced at around 50 dollars, this stethoscope offers professionals a reliable and budget-priced entry-level instrument. This brand also offers a lifetime warranty.
- 5 out of 5.
- Design and Sound Quality
- The American Diagnostic Adscope presents a unique feature–an oversized, ovoid or egg-shaped chest piece. The American Diagnostic Corporation Adscope can be considered of exceptional acoustic quality with this one-sided, single, oversized diaphragm chest piece design that uses light pressure for low frequencies and firm pressure for higher frequencies, called adjustable frequency design or AFD technology.
- This convenience in usage makes the American Diagnostic Adscope a perfect choice for EMTs who would need a quick and versatile tool in emergency situations.
- 4 out of 5.
- Comfort and Durability
- The American Diagnostic Adscope makes use of quality material in its design, with the sculpted chest piece machined from zinc alloy plated with a satin stainless finish, and soft and flexible non-latex, single lumen tubing.
- The Adsoft™ deluxe PVC silicone ear tips and two additional ear-tip pairs, as well as the non-chill diaphragm, ensure the comfort of both patient and practitioner. The headset is also oriented at a steady 15-degree angle, designed to provide a comfortable fit to the user.
- The ovoid-shaped chest piece is also an improvement on the stethoscope’s ergonomic design, aside from enhancing acoustic performance.
- 4 out of 5.
Heine Mini 3000 Otoscope
The Heine Mini 3000 Otoscope is the most popular choice of otoscope for students in the field because of its friendly price. Equipped with Xenon Halogen bulbs for bright illumination, the Mini 3000 Otoscope is a reliable tool for use in hospitals and diagnostic clinics. The unique features of this product include reflect-free illumination, allowing for a clearer visualization of the tympanic membrane and auditory canal. It is also optimally designed for easy use and comfort, with the structurally incorporated swiveling viewing window. All in all, this flexible and high-performing instrument is the true compromise between quality and cost.
- Price 4/5
- Performance 4/5
- Comfort and Durability 5/5
Welch Allyn PocketScope Otoscope
- Needs and Price
- Exceptionally outstanding in durability and acoustic sensitivity, the Cardiology III Stethoscope by 3M Littmann may be considered the best-priced cardiology-grade stethoscope to date. It’s highly-priced at around 200 dollars, but for a good reason–the 3M Littmann Cardiology III Stethoscope provides the standard for acoustic quality and performance. The 3M Littmann Cardiology Stethoscope also comes with a 5-year warranty.
- 4 out of 5.
- Design and Sound Quality
- As expressed in its name, the 3M Littmann Cardiology III Stethoscope is a suitable tool for cardiologists, cardiology and respiratory specialists, and other medical professionals who are looking for high-level performance in auscultation.
- Equipped with a dual-head chest piece of two tunable diaphragms that can be switched for adult or pediatric needs similar to the 3M Littmann Classic III, its versatility makes it a prime choice among medical students and professionals, and its superb acoustics make for its high standards amongst cardiology professionals as well.
- The two-in-one double lumen design is the perfect structural feature that eliminates interfering noise but delivers quality sound to both ear tips through different sound paths.
- 5 out of 5.
- Comfort and Durability
- The angle headset of the 3M Littmann Cardiology III Stethoscope is designed for the user’s comfort and optimal listening.
- Similar to the 3M Littmann Classic III Stethoscope, this instrument also prioritizes headset tension, nonstick tubing, and different tubing lengths.
- 5 out of 5.