{"id":1512,"date":"2010-12-06T11:18:38","date_gmt":"2010-12-06T11:18:38","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/inspection-the-auditory-meatus-a-tympanic-membrane\/"},"modified":"2023-10-26T10:59:00","modified_gmt":"2023-10-26T09:59:00","slug":"inspection-the-auditory-meatus-a-tympanic-membrane","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/the-examination-of-the-ear-nose-mouth-throat-and-neck\/the-ear\/inspection-the-auditory-meatus-a-tympanic-membrane\/","title":{"rendered":"Inspection: The Auditory Meatus &#038; Tympanic Membrane"},"content":{"rendered":"<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Required Instruments<\/strong><\/span><\/h3>\n<ul>\n<li><span style=\"color: #003366;\">Examination lamp.<\/span><\/li>\n<li><span style=\"color: #003366;\">Otoscope<em><strong> [Figure 1]<\/strong><\/em>.<\/span><\/li>\n<li><span style=\"color: #003366;\">Ear specula (<em>disposable<\/em>) <em><strong>[Figure 2]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<h3><span style=\"color: #003366;\"><strong>The Otoscope<\/strong> <\/span><\/h3>\n<p><span style=\"color: #003366;\">An otoscope consists of a <span style=\"color: #33cccc;\"><strong>rechargeable battery tube<\/strong><\/span> [<em>A<\/em>] and an otoscope <span style=\"color: #33cccc;\"><strong>head piece<\/strong><\/span> [<em>B<\/em>]. The latter has a <span style=\"color: #33cccc;\"><strong>contact point<\/strong><\/span> [<em>c<\/em>] for the battery tube. The head piece contains a <span style=\"color: #33cccc;\"><strong>light source<\/strong><\/span> [<em>d<\/em>], with a retractable, 20 diopter <span style=\"color: #33cccc;\"><strong>magnifying lens<\/strong><\/span> located at the top [<em>e<\/em>]. At the front end, there is an <span style=\"color: #33cccc;\"><strong>attachment<\/strong><\/span> for the ear speculum [<em>f]<\/em>.<\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1505\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-1.jpg\" alt=\"\" width=\"400\" height=\"300\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-1.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-1-300x225.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 1<\/span><\/strong><\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Ear Specula<\/strong> <\/span><\/h3>\n<p><span style=\"color: #003366;\">These are <span style=\"color: #33cccc;\"><strong>funnel-shaped pieces<\/strong><\/span> that attach to the head of the otoscope. At the bottom, they are open. There are different speculae available in various diameters. The <span style=\"text-decoration: underline;\">indication<\/span> for the examination determines which diameter is selected. For a regular examination, a <span style=\"color: #33cccc;\"><strong>tip diameter of 4mm<\/strong><\/span> is generally preferred [<em>a<\/em>]. Sometimes, this is too large when examining infants and young toddlers. A tip diameter of 2mm can then be a solution. For therapeutic procedures that are carried out with use of an otoscope (<em>removal of cerumen, ear wax<\/em>) a <span style=\"color: #33cccc;\"><strong>tip diameter of 6mm<\/strong><\/span> is often chosen [<em>b<\/em>].<\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1506\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-2.jpg\" alt=\"\" width=\"400\" height=\"300\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-2.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-2-300x225.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 2<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/122522953?dnt=1&amp;app_id=122963\" width=\"640\" height=\"480\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture\"><\/iframe><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\">Procedure<\/span><\/h3>\n<ul>\n<li><span style=\"color: #003366;\">Remain seated next to the patient as for the auricle examination.<\/span><\/li>\n<li><span style=\"color: #003366;\">Take the otoscope and attach a clean ear speculum (<em>tip diameter 4mm<\/em>) <\/span><span style=\"color: #003366;\"><em><strong>[Figures 6, 7]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1507\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-6.jpg\" alt=\"\" width=\"400\" height=\"299\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-6.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-6-300x224.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 6<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1508\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-7.jpg\" alt=\"\" width=\"400\" height=\"299\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-7.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-7-300x224.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 7<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Take the <span style=\"color: #33cccc;\"><strong>auricle<\/strong><\/span> between thumb and index finger again, and pull it <span style=\"text-decoration: underline;\">posterosuperiorly<\/span> in the direction of the crown of the patient\u2019s head. <\/span><\/li>\n<li><span style=\"color: #003366;\">To make it easier, rest the other three fingers of that hand on the patient\u2019s head.<\/span><\/li>\n<li><span style=\"color: #003366;\">Hold the otoscope in the other hand in a pencil grip.<\/span><\/li>\n<li><span style=\"color: #003366;\">The battery tube can point upwards or downwards <em><strong>[Figures 8, 9]<\/strong><\/em>. <\/span><\/li>\n<li><span style=\"color: #003366;\">When the tip of the speculum is positioned in front of the opening of the auditory meatus, look through the lens [<em><strong>Figure 10]<\/strong><\/em> and insert the speculum until halfway into the <span style=\"color: #33cccc;\"><strong>auditory meatus<\/strong><\/span> without causing discomfort to the patient. <\/span><\/li>\n<li><span style=\"color: #003366;\">The skin that covers the <span style=\"color: #33cccc;\"><strong>auditory meatus<\/strong><\/span>, which will now be in view, should be smooth without any redness. <\/span><\/li>\n<li><span style=\"color: #003366;\">It is often covered in a thin layer of <span style=\"color: #33cccc;\"><strong>cerumen<\/strong><\/span>. <\/span><\/li>\n<li><span style=\"color: #003366;\">Sometimes, this material is also present in little clumps in the auditory meatus. <\/span><\/li>\n<li><span style=\"color: #003366;\">These can vary in colour from <span style=\"text-decoration: underline;\">yellow-brown<\/span> to <span style=\"text-decoration: underline;\">deep red-brown<\/span>, or even <span style=\"text-decoration: underline;\">black<\/span>. <\/span><\/li>\n<li><span style=\"color: #003366;\">In some cases, this can close off the auditory meatus completely and the cerumen may even be rock hard. <\/span><\/li>\n<li><span style=\"color: #003366;\">If <span style=\"color: #33cccc;\"><strong>pus<\/strong><\/span> is observed in the auditory meatus, you should check whether it is coming from the walls of the auditory meatus or from structures located deeper inside the ear.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1509\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-8.jpg\" alt=\"\" width=\"400\" height=\"299\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-8.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-8-300x224.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 8<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1510\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-9.jpg\" alt=\"\" width=\"400\" height=\"299\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-9.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-9-300x224.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 9<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1511\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-10.jpg\" alt=\"\" width=\"400\" height=\"299\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-10.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-10-300x224.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 10<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">At the end of the auditory meatus, the <span style=\"color: #33cccc;\"><strong>tympanic membrane<\/strong><\/span> can be seen. <\/span><\/li>\n<li><span style=\"color: #003366;\">The part that can be observed through the speculum is approximately one-fourth of the total surface area of the tympanic membrane.<\/span><\/li>\n<li><span style=\"color: #003366;\">The speculum should be moved carefully inside the auditory meatus to inspect the complete tympanic membrane. <\/span><\/li>\n<li><span style=\"color: #003366;\">Caution is required as the wall of the auditory meatus is pain-susceptible, because the skin is quite tightly stretched over the supporting bone and cartilage tissue.<\/span><\/li>\n<\/ul>\n<hr \/>\n<ul>\n<li>You should first look for the <span style=\"color: #33cccc;\"><strong>cone of light<\/strong><\/span><span style=\"color: #003366;\">.<\/span><\/li>\n<li><span style=\"color: #003366;\">This is observed in the <span style=\"text-decoration: underline;\">anterior lower quadrant<\/span> of the tympanic membrane. <\/span><\/li>\n<li><span style=\"color: #003366;\">Because the tympanic membrane is a <span style=\"text-decoration: underline;\">conical structure<\/span> directed inwards and illuminated from a sloping angle, it reflects the light in the shape of a <span style=\"text-decoration: underline;\">triangle<\/span>. <\/span><\/li>\n<li><span style=\"color: #003366;\">This varies in <span style=\"color: #33cccc;\"><strong>width<\/strong><\/span>, based on the <span style=\"text-decoration: underline;\">slope of the walls<\/span> of the funnel. <\/span><\/li>\n<li><span style=\"color: #003366;\">The steeper the slope, the narrower the light reflection, the flatter the wall, the wider the light reflection.<\/span><\/li>\n<li><span style=\"color: #003366;\">The <span style=\"text-decoration: underline;\">width of the reflection<\/span> of the light provides information about the <span style=\"color: #33cccc;\"><strong>position<\/strong><\/span> of the tympanic membrane.<\/span><\/li>\n<li><span style=\"color: #003366;\">This is an indication of <span style=\"color: #33cccc;\"><strong>processes<\/strong><\/span> taking place inside the middle ear. <\/span><\/li>\n<li><span style=\"color: #003366;\">If there is <span style=\"text-decoration: underline;\">decreased pressure<\/span> inside the middle ear because of <span style=\"text-decoration: underline;\">dysfunction<\/span> of the <span style=\"color: #33cccc;\"><strong>Eustachian tube<\/strong><\/span>, the tympanic membrane will be pulled <span style=\"text-decoration: underline;\">inwards<\/span>, be <span style=\"text-decoration: underline;\">more conical<\/span> and the <span style=\"color: #33cccc;\"><strong>light reflex<\/strong><\/span> will be <span style=\"text-decoration: underline;\">smaller than normal<\/span>. <\/span><\/li>\n<li><span style=\"color: #003366;\">If there is a lot of <span style=\"text-decoration: underline;\">pus<\/span> present in the middle ear, the tympanic membrane will be pushed <span style=\"text-decoration: underline;\">outwards<\/span>, with the exception of the place where it is attached to the handle of the malleus. <\/span><\/li>\n<li><span style=\"color: #003366;\">In such situations, it takes the shape of a <span style=\"color: #33cccc;\"><strong>halo<\/strong><\/span>. <\/span><\/li>\n<li><span style=\"color: #003366;\">Because of its convex position, nearly the whole surface will be <span style=\"text-decoration: underline;\">illuminated diffusely<\/span>. <\/span><\/li>\n<li><span style=\"color: #003366;\">There are also <span style=\"text-decoration: underline;\">intermediate positions<\/span> possible between this extreme position and a normal position.<\/span><\/li>\n<li><span style=\"color: #003366;\">These give an indication of the degree of <span style=\"color: #33cccc;\"><strong>excess pressure<\/strong><\/span> inside the middle ear.<\/span><\/li>\n<\/ul>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">When moving the otoscope upwards to the <span style=\"text-decoration: underline;\">anterior upper quadrant<\/span>, you will see the thinner <span style=\"color: #33cccc;\"><strong>Shrapnell\u2019s membrane<\/strong><\/span> underneath which the malleus is outlined. <\/span><\/li>\n<li><span style=\"color: #003366;\">This membrane also provides information about the <span style=\"color: #33cccc;\"><strong>position<\/strong><\/span> of the tympanic membrane. <\/span><\/li>\n<li><span style=\"color: #003366;\">Normally, it lies closely <span style=\"text-decoration: underline;\">against<\/span> the tympanic membrane. <\/span><\/li>\n<li><span style=\"color: #003366;\">During decreased pressure in the middle ear, the tympanic membrane becomes <span style=\"text-decoration: underline;\">tightly stretched<\/span> over this structure; and the <span style=\"color: #33cccc;\"><strong>malleus<\/strong><\/span>\u00a0<span style=\"text-decoration: underline;\">protrudes<\/span> into the auditory meatus. <\/span><\/li>\n<li><span style=\"color: #003366;\">During increased pressure, the malleus lies <span style=\"text-decoration: underline;\">deeper<\/span> inside the ear than the tympanic membrane.<\/span><\/li>\n<\/ul>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Subsequently, move the otoscope towards the <span style=\"text-decoration: underline;\">posterior upper quadrant<\/span> and the <span style=\"text-decoration: underline;\">posterior lower quadrant<\/span>.<\/span><\/li>\n<li><span style=\"color: #003366;\">The <span style=\"text-decoration: underline;\">colour<\/span> of the tympanic membrane is usually <span style=\"color: #33cccc;\"><strong>pearly grey<\/strong><\/span>. <\/span><\/li>\n<li><span style=\"color: #003366;\">When the tympanic membrane is <span style=\"text-decoration: underline;\">irritated<\/span> because of <span style=\"text-decoration: underline;\">mild inflammation<\/span>,\u00a0there may be presence of <span style=\"color: #33cccc;\"><strong>vessel injection<\/strong><\/span>. <\/span><\/li>\n<li><span style=\"color: #003366;\">Within <span style=\"text-decoration: underline;\">severe inflammatory processes<\/span>, this may lead to the tympanic membrane being <span style=\"color: #33cccc;\"><strong>bright red<\/strong><\/span> in colour.<\/span><\/li>\n<li><span style=\"color: #003366;\">If there is a <span style=\"text-decoration: underline;\">long-term presence<\/span> of (<em>viscous<\/em>) <span style=\"color: #33cccc;\"><strong>mucous effusion<\/strong><\/span> in the tympanic cavity, the tympanic membrane can appear <span style=\"color: #33cccc;\"><strong>yellow-brown<\/strong><\/span> or <span style=\"color: #33cccc;\"><strong>purple-blue<\/strong><\/span> in colour due to the substance showing through (<em>glue ear<\/em>).<\/span><\/li>\n<\/ul>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">The tympanic membrane can <span style=\"text-decoration: underline;\">rupture<\/span> under <span style=\"color: #33cccc;\"><strong>excessive pressure<\/strong><\/span> increase in the middle ear, or through <span style=\"color: #33cccc;\"><strong>damage<\/strong><\/span> incurred from the outside (<em>inserting a sharp item into the ear, cleaning the ear with a cotton bud, sudden loud bangs<\/em>). <\/span><\/li>\n<li><span style=\"color: #003366;\">This is known as a <span style=\"color: #33cccc;\"><strong>perforation<\/strong><\/span>. <\/span><\/li>\n<li><span style=\"color: #003366;\">Spontaneous perforations occur most frequently in the <span style=\"text-decoration: underline;\">anterior upper quadrant<\/span>. <\/span><\/li>\n<li><span style=\"color: #003366;\">When these perforations heal, <span style=\"color: #33cccc;\"><strong>scar tissue<\/strong><\/span> develops. <\/span><\/li>\n<li><span style=\"color: #003366;\">Both perforations and scar tissue can <span style=\"text-decoration: underline;\">impede vibration<\/span> of the tympanic membrane, thereby giving hearing problems. <\/span><\/li>\n<li><span style=\"color: #003366;\">The <span style=\"text-decoration: underline;\">intactness<\/span> of the tympanic membrane is therefore an important focal point.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong>Inspection Of The Tympanic Membrane<\/strong><\/span><\/p>\n<p><span style=\"color: #003366;\">A normal tympanic membrane is a <span style=\"color: #33cccc;\"><strong>thin<\/strong><\/span>, <span style=\"color: #33cccc;\"><strong>transparent structure<\/strong><\/span> through which the elements located inside the tympanic cavity can sometimes be visible. Particularly the malleus, the incus and the round window niche can be distinguished. Effusions are detectable in the middle ear because of their colour. Occasionally, air bubbles can be seen in the fluid as well as a fluid level.<\/span><\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Required Instruments Examination lamp. Otoscope [Figure 1]. Ear specula (disposable) [Figure 2]. The Otoscope An otoscope consists of a rechargeable battery tube [A] and an otoscope head piece [B]. The latter has a contact point [c] for the battery tube. The head piece contains a light source [d], with a retractable, 20 diopter magnifying lens [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[37],"tags":[132],"class_list":["post-1512","post","type-post","status-publish","format-standard","hentry","category-the-ear","tag-the-examination-of-the-ear-nose-mouth-throat-and-neck"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Inspection: The Auditory Meatus &amp; Tympanic Membrane - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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