What is an ear examination?
Your doctor will perform an ear examination, or otoscopy, if you have:
- an earache
- an ear infection
- hearing loss
- ringing in your ears
- any other ear-related symptoms
Your doctor can examine your ear to diagnose an ear infection or to see if treatments for an ear condition are working. Ear infections are common, especially in children.
Your doctor may also perform an ear exam if you’ve had or are experiencing the following:
- a head injury
- chronic ear infections
- a punctured eardrum
An ear exam may be slightly uncomfortable or painful if you have an ear infection. Your doctor will stop the exam and remove the otoscope if the pain worsens.
Your doctor may dim the lights in the exam room to make it easier to see your ear canal and eardrum with an otoscope. An otoscope is a handheld light with a removable plastic tip shaped like a cone that allows the doctor to look inside your ear.
Your doctor will gently pull in the following directions to straighten your ear canal:
- up
- down
- forward
- back
Then, they’ll place the tip of the otoscope into your ear and shine a light into your ear canal and down to your eardrum. They’ll carefully rotate the otoscope in different directions to see the inside of your ear and your eardrum.
Your doctor may use a pneumatic otoscope, which has a plastic bulb on the end, to blow a small puff of air against your eardrum. Normally, this air will cause your eardrum to move. Your doctor will see little or no movement if you have an infection and fluid buildup behind your eardrum.
Young children will be asked to lie on their backs with their heads turned to the side to allow the doctor to examine one ear at a time. Older children and adults can sit up, tilting their heads to the side to allow the doctor to examine each ear.
You can purchase an otoscope to check your child’s ears at home if you think they may have an ear infection. Contact their doctor right away if you see any of the following in your child’s ears:
- redness
- swelling
- fluid
- pus
There are very few risks associated with an ear exam. If your doctor doesn’t change the tip of the otoscope or clean it properly after examining your ear, they can spread the infection from one ear to the other.
Normally, your ear canal is skin-colored and your eardrum is light gray or pearly white. The light should reflect off of a healthy eardrum. You may also have some yellow or brown earwax, which isn’t harmful. If your ear canal and eardrum appear healthy, you mostly likely don’t have an ear infection.
If your doctor identifies any of the following in your ear canal or behind your eardrum, you most likely have an ear infection:
- redness
- swelling
- amber liquid
- pus
If the light doesn’t reflect off of your eardrum, it’s another indication that fluid may have collected behind the eardrum due to an infection.
Ear infections are generally easily diagnosed based on the symptoms and the observations the doctor makes by looking at the eardrum.
If you don’t respond to the antibiotics your doctor prescribes and your symptoms don’t get better, there are other diagnostic examinations your doctor can perform to identify the cause of your discomfort. Here are some other tests that your doctor might run if this happens:
- Your doctor can use tympanometry to look specifically at an infection in the middle ear, which is behind the eardrum.
- During a tympanocentesis, your doctor inserts a tube into the ear and pierces the eardrum to drain fluid. Doctors rarely perform this test.
- Your doctor can use acoustic reflectometry to measure how much sound your eardrum reflects. The more sound your eardrum reflects back, the more pressure from fluid your eardrum likely has.
Test Overview
An ear examination is a thorough check of the ears. It is done to screen for ear problems, such as hearing loss, ear pain, discharge, lumps, or objects in the ear. An ear examination can find problems in the ear canal, eardrum, and middle ear. These problems may include infection, too much earwax, or an object like a bean or a bead.
During an ear examination, a tool called an otoscope is used to look at the outer ear canal and eardrum. An otoscope is a hand-held tool with a light and a magnifying lens. It also has a funnel-shaped viewing piece with a narrow, pointed end called a speculum. A pneumatic otoscope has a rubber bulb that your doctor can squeeze to give a puff of air into the ear canal. The air helps the doctor to see how the eardrum moves.
Why It Is Done
An ear examination may be done:
- As part of a routine physical examination.
- As part of the process to screen newborns for hearing loss.
- To find the cause of symptoms such as earache, a feeling of pressure or fullness in the ear, or hearing loss.
- To check for excess wax buildup or an object in the ear canal.
- To find the location of an ear infection. The infection may just be in the external ear canal [otitis externa]. Or it might be in the middle ear behind the eardrum [otitis media].
- To see how the treatment for an ear problem is working.
How To Prepare
It is important to sit very still during an ear examination. A young child should be lying down with their head turned to the side. Or the child may sit on an adult's lap with the child's head resting securely on the adult's chest. Older children and adults can sit with the head tilted slightly toward the opposite shoulder.
Your doctor may need to remove earwax in order to see the eardrum.
How It Is Done
An ear examination can be done in a doctor's office, a school, or the workplace.
For an ear examination, the doctor uses a special tool called an otoscope to look into the ear canal and see the eardrum.
Your doctor will gently pull the ear back and slightly up to straighten the ear canal. For a baby under 12 months, the ear will be pulled downward and out to straighten the ear canal. The doctor will then insert the pointed end [speculum] of the otoscope into the ear and gently move the speculum through the middle of the ear canal to avoid irritating the canal lining. The doctor will look at each eardrum [tympanic membrane].
Using a pneumatic otoscope lets your doctor see what the eardrum looks like. It also shows how well the eardrum moves when the pressure inside the ear canal changes. It helps the doctor see if there is a problem with the eustachian tube or fluid behind the eardrum [otitis media with effusion]. A normal eardrum will flex inward and outward in response to the changes in pressure.
How It Feels
The physical examination of the ear using an otoscope usually isn't painful. If you have an ear infection, putting the otoscope into the ear canal may cause mild pain.
Risks
The pointed end of the otoscope can irritate the lining of the ear canal. This can often be avoided by putting the otoscope in slowly and carefully. If the otoscope does scrape the lining of the ear canal, it could cause bleeding or infection, but this is rare.
Results
Results of an ear examination
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Credits
Current as of: September 8, 2021
Author: Healthwise Staff
Medical Review:
Susan C. Kim MD - Pediatrics
E. Gregory Thompson MD - Internal Medicine
Kathleen Romito MD - Family Medicine
Charles M. Myer III MD - Otolaryngology