The remainder of the examination of the ear is performed with the otoscope. The otoscope incorporates a halogen light source and fiberoptic circumferential distribution of the light. This provides a 360° ring of light-conducting fibers within the shell of the otoscope through which the observer views the inner structures of the ear. Most otoscopes are illuminated by a bright quartz halogen bulb requiring a 3.5-V power supply. Specially designed reusable or disposable polypropylene specula slip over the tip of the instrument. Most otoscopic heads can be used with a rubber squeeze bulb for pneumatic otoscopy (described later in this chapter). Take care in the use of the otoscope. The best visualization of the structure does not require the speculum to be wedged into the canal. Be gentle, to achieve the best view of the anatomy.
Choose the correct speculum size: small enough to prevent discomfort to the patient and large enough to provide an adequate beam of light. Usually a tip 4 to 6 mm in diameter is used for adults, 3 to 4 mm in diameter for children, and 2 mm in diameter for infants.
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