Procedure
- The patient sits on a chair with good back support [Figure 3].
- Sit down beside the patient on a height-adjustable stool.
- Your eyes should be located at the level of the ear that is to be examined.
Figure 3
- Aim the examination lamp at the ear that is to be examined.
- The auricle is usually covered by smooth skin without any redness or swelling.
- If this is not the case, palpate the red area with the dorsal side of your finger to determine if this area is warmer than the surrounding skin.
- Any swelling present should be palpated between thumb and index finger to determine the consistency and borders.
- Pay attention to the patient’s face or enquire whether the pressure you are applying is painful.
- If you see any ear piercings in the lobule or the helix, palpate these as well and pay attention to the surrounding areas of these perforations in case they are solid, warm, or painful [Figure 4].
Figure 4
- Subsequently, inspect the opening of the external auditory meatus.
- Normally, this is clean or has a small quantity of yellow-brown cerumen.
- Discharge of pus out of the ear always indicates inflammation of the more internally located structures of the ear.
- Briefly press the tragus and ask the patient whether this is painful or exacerbates any existing pain.
- Take the upper ridge of the auricle between thumb and index finger and pull this posterosuperiorly, towards the crown of the patient’s head [Figure 5].
- By doing this, the frontal part of the auditory meatus becomes accessible for inspection.
- The auditory meatus is covered in skin.
Figure 5
- A few hairs are detectable here and/or some yellow-brown cerumen.
- Normally, the skin is pink in colour.
- Redness, swelling or a coating layer other than cerumen are considered abnormal.
- In children, it is often necessary to pull the auricle anteroinferiorly.
- This is due to the difference in anatomy of the auditory meatus.