Objective Physical Examination of the Ear

Palpation and Tenderness

Palpation involves moving the pinna and applying pressure to the tragus.

• Otitis Externa or Furuncle: Indicated by severe pain during movement of the pinna or tragus.
• Mastoiditis or Lymphadenitis: Pain specifically at the mastoid process may indicate infection of the bone or inflammation of the posterior auricular lymph nodes.

Otoscopic Examination

The otoscopic exam allows for direct visualization of the external auditory meatus and the tympanic membrane (TM).

The External Auditory Meatus

The clinician must first note the size of the canal opening to select the correct speculum size.

• Abnormalities: The canal should be free of swelling, redness, or discharge. Atresia (the absence or closure of the canal) and the presence of foreign objects (common in children) are critical findings.
• Cerumen: Excessive or impacted earwax can obscure the eardrum and should be noted.

The Tympanic Membrane (Eardrum)

The TM is the most critical structure to observe. A normal eardrum is shiny, translucent, and pearl-grey.

Anatomy of a Normal Eardrum: Through the translucent membrane, the clinician should be able to see parts of the malleus, including the umbo, manubrium, and short process. A prominent, cone-shaped light reflex should be visible in the anteroinferior quadrant:

• Right Ear: 5:00 position.
• Left Ear: 7:00 position.

Interpreting Abnormal Otoscopic Findings

The appearance of the TM provides significant clues regarding the underlying pathology:

Hearing Acuity and Patient Care

Testing Hearing

To assess hearing acuity objectively, clinicians may use the Whispered Voice Test. The clinician whispers a series of numbers or letters to the patient one ear at a time; an inability to repeat them may indicate high-tone (high-frequency) loss.

Hearing Aid and Ear Health Management

For patients using hearing aids, clinicians should provide the following guidance:

1. Adaptation: Initially use the device in quiet settings at home.
2. Storage: Store in a dry, cool area; do not wear them continuously when not in use.
3. Maintenance: Remove batteries when not in use and clean ear moulds weekly.

To prevent hearing loss from digital devices, clinicians recommend the 60–60 rule: listen to music for no more than 60 minutes per day at no more than 60% of the maximum volume.

Clinical Tip: Screening Intervals General hearing screening should occur every three years starting at age 2. However, individuals over age 65 or those working in high-noise industrial environments should see an audiologist annually.