Immersion: Ear

Landmarks and structures

Exam steps

Step 1. Inspect the auricle and mastoid

Observe for swelling, erythema, and skin lesions – the ear is a common site for skin cancers.

Step 2. Assess hearing

Hold your fingers an equal distance from each ear and rub the fingers on one side together, asking which ear they can hear the sound in. Compare one side to the other and to your ability to hear the sound. This is an insensitive test for loss of hearing but can easily be done at the bedside.

Step 3. Perform otoscopy

• Stand on the patient’s left to examine the left ear
• With your right hand, gently pull the left ear up and back to straighten the ear canal.
• Hold the otoscope in your left hand with the thumb and first two fingers, like a pen, or around the barrel as Dr. Kirchhoff does in the video. To stabilize your hand, you can brace your little finger against your patient’s forehead – this is particularly important for children, who might move unexpectedly.
• Place the otoscope partway into the external auditory canal, looking through it as you do.
• Examine the canal, the tympanic membrane, and visible structures of the middle ear. The tympanic membrane should look like the example above, with the cone of light in the anterior, inferior quadrant.
• Repeat for the right ear, switching sides and holding the otoscope in your right hand

For a young child, you will need a caregiver’s assistance in immobilizing the head and you’ll need to adjust your technique slightly – the ear will be pulled down to straighten the canal rather than up and back as in an adult.

Ear Exam Video