Student Source > POM1 > Physical Exam > HEENT Exam




External ear - observe position and shape, inspect for symmetry, lesions, drainage from external auditory meatus

•  Position: Top of auricle should be above line drawn between outer canthus of eye and occipital protuberance. Low set auricle may signify chromosomal abnormality.

•  Possible findings

•  Tophi-   deposits of uric acid crystals found in patients with gout

•  Chondritis- infection of cartilage, often caused by piercing

•  "Cauliflower"-repeated trauma causes cartilage necrosis

•  Otitis externa- "swimmer's ear", pulling on lobe often painful

•  Skin cancer - often nodular, with induration, scaling and superficial ulceration.

•  Middle ear - otoscopic exam

•  Technique

Click on the player to watch the video:

•  Use largest speculum that is comfortable

•  Learn a comfortable hold for the otoscope

•  Insert otoscope slowly, avoiding bumping the canal - "Look your way in" - while manipulating the auricle.

•  In an adult pull posteriorly and superiorly to straighten the auditory canal

•  In an infant and child, pull auricle posteriorly and inferiorly to straighten the auditory canal.

•  Cerumen removal may be necessary

•  Cerumen spoon- often causes EAC bleeding

•  Irrigation - contraindicated if TM perforation

•  Removal with direct visualization

•  Pneumatic otoscopy

•  assesses mobility and compliance of TM

•  Air pressure should move TM- light reflex looks like a sail in wind

See Normal Mobility video

•  Effusion (fluid in middle ear) will hamper TM mobility

•  Retraction from eustachian tube dysfunction may allow movement only with negative pressure

•  A specially designed speculum (soft rubber tip) allows you to seal EAC more easily

See Abnormal Mobility video

•  Findings

•  Mobility

•  Bulging, no mobility                Pus in middle ear- otitis media (OM)

•  Retracted, no mobility              Eustacian tube dysfunction +/- effusion

•  Color

•  Red                                           Infection, crying

•  Deep red or blue                       Blood (from trauma)

•  White flecks, plaques               Healed inflammation

•  Bubbles                              Serous fluid

  • Acute Otitis Media

  • Otitis Media with Effusion (Serous Otitis)

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