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External Ear Examination by Using Bull's Lamp and Reflective Mirror

Traditional method of external ear examination by using light source from Bull's lamp and reflected by head mirror.  Today, this technique was superseded by using electric or battery operated headlights utilizing Xenon bulb or LED (light emitting diode).

Principles of Otoscopy

Otoscopic Examination

Preliminary external ear examination     Correct speculum size selected (largest

under good illuminations, followed by     which can fit nicely into the introitus). 

gentle palpation to elicit area of local     Otoscope being held as shown with the

tenderness.  Pinna is being pulled         ulna side of little and ring fingers resting

downward in neonates,backward in        gently onto the patient's face.  Then, the

children, and upward and posteriorly      examining eye see through the eyepiece. in adults.                                             Systematic examination of the ear canal

                                                          and eardrum performed and findings 

                                                          recorded appropriately.   

Tympanic Membrane Mobility Testing

This test is usually done clinically by performing siegelisation or by using a    pneumatic otoscope while the patient performs valsalva manouevre.  Outward bulge is seen when the pressure in the middle ear cleft exceeded the atmospheric  pressure (above the opening threshold of the eustachian tube).  Similar effect is to be seen upon blowing nasal balloon.  The reverse movement (indrawing) is seen upon swallowing with the mouth and nostrils closed; the so called Toynbee manouevre.  Modern days technique incorporate otoendoscopy for the sharper image and detecting even the subtle mobility. This figure shows the bulging of eardrum soon after the patient performs valsalva manouevre.

 

Normal Eardrum Mobility.

 

Retraction & Selective Dysventilation Syndrome.

Endoscopic Ear Examination (Otoendoscopy)

 

An example of portable otoendoscope with attached camera head and wiewing panel is shown.  Research and development in optics and image processing had enable ear canal and the eardrum to be seen more clearly with the advantage of still image capture and archiving for record keeping and documentation purposes.

Portable Video-Otoscopy

 

 Otoscope adapter in-use.

A large right eardrum perforation captured using the device.

 

 The normal left side.

 

Both images were captured using the same device without photo-editing done.

Portable Video-Endoscopy

An example of a portable video endoscopy system.  It has a built-in rechargable battery with capability for photo capture and video recording.

 An actual example of endoscopic picture taken using the above device in a child having resolving left acute otitis media.

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