Products
Otoscopes provide a direct and magnified view of the external auditory canal and the tympanic membrane, yielding diagnostic information about outer- and middle-ear pathology. In addition, depending on the design, otoscopes may also aid in simple foreign-body removal from the external auditory canal or enable pneumatic evaluation of the tympanic membrane.
Category
Otoscopes
Device details
Different types of otoscopes are currently available. They can be classified as direct or indirect (video otoscope) and wall-mount or battery-operated (portable). Some common available otoscopes are listed below
Direct diagnostic otoscopes
Welch Allyn
- 3.5 V Diagnostic Otoscope (see image below)
3.5 V Diagnostic Otoscope (Welch Allyn®) - MacroView™ Otoscope (see image below)
MacroView™ Otoscope (Welch Allyn®)
Riester
- Ri-scope® L1 Otoscope (see image below)
Ri-scope® L1 Otoscope (Riester®)
Heine
- Heine BETA 100® Diagnostic Otoscope (see image below)
Heine BETA 100® Diagnostic Otoscope (Heine®)
American Diagnostic Corporation
- 2.5 V Otoscope 5211 (see image below)
2.5 V Otoscope 5211 (American Diagnostic Corporation®)
Indirect diagnostic otoscopes
Welch Allyn
- Digital MacroView™ Otoscope (see image below)
Digital MacroView™ Otoscope (Welch Allyn®)
Firefly
- Firefly DE550 Digital Wireless Video Otoscope (see image below)
Firefly DE550 Digital Wireless Video Otoscope. Image courtesy of www.fireflyglobal.com
AnMo Electronics Corp
- Dino-Lite™ Pro Earscope (see image below)
Dino-Lite™ Pro Earscope (AnMo Electronics Corp®)
JEDMED
- JEDMED Video Otoscope (see image below)
JEDMED Video Otoscope (JEDMED ®)
Pneumatic otoscopes
Welch Allyn
- 3.5 V Pneumatic Otoscope (see image below)
3.5 V Pneumatic Otoscope (Welch Allyn®)
Riester
- Riester uni® Otoscope (see image below)
Riester uni® Otoscope
Operating otoscopes
Welch Allyn
- 3.5 V Operating Otoscope (see image below)
3.5 V Operating Otoscope (Welch Allyn®)
Heine
- Heine Operating Otoscope (see image below)
Heine Operating Otoscope (Heine®)
Riester
- Ri-scope® Operating Otoscope (see image below)
Ri-scope® Operating Otoscope
Design Features
Standard diagnostic otoscopes
Multiple manufacturers produce standard diagnostic otoscopes, which typically come with 4 components.
The otoscope head provides illumination and magnification of the ear canal and tympanic membrane. Most standard otoscope heads have a port to which the insufflator is attached, allowing pneumatic otoscopy to be performed. The viewing window can swivel or slide to the side, allowing for instrumentation of the ear canal; however, this varies depending on the specific otoscope and the manufacturer. Magnification is lost when the eyepiece is moved.
The handle, which is attached to the otoscope head, provides the power source for the light bulb, which may come from rechargeable batteries in the handle (portable) or from the power outlet (wall unit).
The speculum is attached to the otoscope head and is inserted into the ear canal for examination. Speculums come in difference sizes to accommodate the different canal sizes. In addition, some speculums are designed with a wider body, while others have a rubber adapter to provide a good seal to the canal wall for effective pneumatic otoscopy.
Indirect otoscopes
Indirect otoscopes have recently become available. The advantages of indirect and digital otoscopes are that they allow images and videos to be captured and stored, allowing patients to visualize their own anatomy. They also allow for synchronous and asynchronous telemedicine consultation across large geographic distances when used in conjunction with high-bandwidth video teleconferencing.[1] The signal output of such devices can be directed to an onsite television or computer monitor or transmitted to a remote telemedicine consultation site. Instrumentation of the canal is not possible with video otoscopes.
Pneumatic otoscopes
Pneumatic otoscopes typically provide a higher magnification and wider field of view than standard otoscopes. They also have a tighter eyepiece seal, which reduces the air leak that may occur during pneumatic otoscopy. Of note, most standard otoscopes today also have an adaptor for an insufflator to facilitate pneumatic otoscopy without the need to use a separate pneumatic otoscope.
Operating otoscopes
The operating otoscope is an open system with a smaller eyepiece that can be swiveled to accommodate instrumentation through the speculum. The disadvantages are that the eyepiece is smaller than that of the standard scope and that pneumatic otoscopy cannot be performed. The operating otoscope can be used for simple cerumen or foreign body removal in the lateral canal wall.
Indications
Otoscopy is primarily indicated for routine external and middle ear examination, as well as to assist in diagnosing various external and middle ear pathologies. Some of these disorders include external auditory canal stenosis, cerumen impaction, otitis externa, exostoses, osteoma, foreign body, tympanic membrane perforation, myringitis, otitis media, eustachian tube dysfunction, and cholesteatoma.
Depending on the type and style, an otoscope can be used to assist in debridement of cerumen, removal of simple foreign bodies, and placement of ear mold impressions.
Clinical Implementation
Almost all modern otoscopes use clean disposable specula to reduce risks of infectious cross-contamination between patients or ears. Specula typically come in adult and pediatric sizes. The appropriate speculum is chosen based on the size of the canal and fit it to the otoscope.
Once the light source is turned on, the pinna is manually retracted posteriorly and superiorly with the free hand to straighten the canal. The otoscope should be held with the hand of the same side as the side of the patient’s ear that is being examined. Ideally, the otoscope is held between the thumb, index finger, and middle finger. The fourth and fifth fingers are placed against the patient’s cheek or temple to stabilize the otoscope and to guard against trauma with sudden movements, particularly in children. The speculum is inserted slowly and gently into the canal.
Examination of the external auditory canal should be complete and thorough. Begin at the lateral external auditory canal and inspect the skin circumferentially for any surface irregularities or underlying masses. The canal may contain cerumen, foreign bodies, discharge, or debris. Variable amounts of cerumen may be encountered in the canal, which can preclude any further inspection until debrided. If adjusting the otoscope medially under direct visualization, the examiner should be careful to avoid traumatizing the canal skin, particularly at the bony-cartilaginous junction, with the leading edge of the speculum or causing other trauma to the canal skin.
Medially, the tympanic membrane is visualized. The tympanic membrane should always be examined in its entirety. Rotate the otoscope to visualize the margin of the tympanic membrane circumferentially. Note the color (pink, white, yellow), translucency (opaque, transparent), vascularity, and position (retracted, neutral, bulging) of the ear drum. Air bubbles or air-fluid level behind the drum is suggestive of middle ear fluid. Identify the pars tensa, pars flaccida, umbo, manubrium of the malleus, the light reflex (cone of light) and any abnormal findings.[2, 3]
It is important to ensure that the pars flaccida is directly visualized during otoscopy, as this area is the most common location of acquired cholesteatomas. If a perforation is noted, identify the location and estimate the size. The presence of white debris in the middle ear or under the tympanic membrane is suggestive of a cholesteatoma. Of note, a severely stenotic or tortuous canal can limit the view of the tympanic membrane. The difference between a complete perforation and complete atelectasis of the tympanic membrane may be confusing on initial evaluation, particularly for examiners who are not familiar with the breadth of otologic pathology or who perform otoscopy infrequently.
To assess tympanic membrane mobility, an insufflator bulb is attached to the otoscope head. After ensuring an airtight seal to the ear canal with a normal or pneumatic speculum, the pneumatic insufflator is squeezed and released while the tympanic membrane is visualized. Normally, the tympanic membrane should move with both positive and negative insufflation. Immobility is suggestive of tympanic membrane or middle ear pathology, including tympanic membrane perforation or middle ear effusion.[2]
Follow-up/Monitoring
For additional follow-up and monitoring of various external and middle ear pathologies, see Cerumen Impaction Removal, Otitis Externa, Ear Foreign Body Removal Procedures, Acute Otitis Media, Middle Ear, Eustachian Tube, Inflammation/Infection, and/or Cholesteatoma, among others.
Complications
Complications related to otoscope use are rare. With careful use, canal trauma can be avoided when the ear is examined under direct visualization and precaution is taken to guard the otoscope against sudden head movement. For complications related to various external and middle ear pathology, see Cerumen Impaction Removal, Otitis Externa, Ear Foreign Body Removal Procedures, Acute Otitis Media, Middle Ear, Eustachian Tube, Inflammation/Infection, and/or Cholesteatoma, among others.
Jones WS. Video otoscopy: bringing otoscopy out of the "black box". Int J Pediatr Otorhinolaryngol. Nov 2006;70(11):1875-83. [Medline].
Shaikh N, Hoberman A, Kaleida PH, Ploof DL, Paradise JL. Videos in clinical medicine. Diagnosing otitis media--otoscopy and cerumen removal. N Engl J Med. May 20 2010;362(20):e62. [Medline].
Chang P, Pedler K. Ear examination--a practical guide. Aust Fam Physician. Oct 2005;34(10):857-62. [Medline].
Morris E, Kesser BW, Peirce-Cottler S, Keeley M. Development and Validation of a Novel Ear Simulator to Teach Pneumatic Otoscopy. Simul Healthc. Sep 21 2011;[Medline].
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