The Techniques

To examine the patient's right ear, the examiner holds the otoscope in the right hand. The canal is straightened by the examiner's left hand pulling the pinna up, out, and back. The straighter the canal, the easier the visualization and the more comfortable the examination is for the patient.

In a child, the canal should be straightened by pulling the pinna down and back. The patient is asked to turn his or her head to the side slightly so that the examiner can examine the ear more comfortably. The otoscope may be held in either of two positions. The first, and preferred, position involves holding the otoscope like a pencil, between the thumb and index finger, in a downward position with the ulnar aspect of the examiner's hand braced against the side of the patient's face. This position provides a buffer against sudden movement by the patient. By holding the end of the otoscope's handle, the examiner then angles the speculum into the external canal. This technique at first feels more cumbersome than the alternative technique, but it is safer, especially for children. This technique is shown in Figure 11-14.

The second position involves holding the otoscope upward as the speculum is introduced into the canal. This technique feels more comfortable, but a sudden movement by the patient can cause pain and injury to the patient. This technique is shown in Figure 11-15.

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