Use of the otoscope in athletic training
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Use of the Otoscope in Athletic Training. Objectives. Briefly discuss the types and features of the otoscope Provide an overview of otoscopic assessment procedures Present a clinical teaching model for teaching your students to properly use the otoscope

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Use of the Otoscope in Athletic Training

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Use of the Otoscope in Athletic Training


Objectives

  • Briefly discuss the types and features of the otoscope

  • Provide an overview of otoscopic assessment procedures

  • Present a clinical teaching model for teaching your students to properly use the otoscope

  • Provide educational resources for teaching otoscopy


Types & Features of the Otoscope


Types of Otoscopes

  • Pocket style

    • < $50

  • Clinical model

    • $200 - $400+

Pocket style

Clinical model


Features of the Otoscope

  • Power source

    • Battery (most common in athletic training clinical setting)

    • Electric

  • Light source

    • Incandescent bulb (produces a yellow light)

    • Hallogen bulb (best – produces a white light)


Features of the Otoscope

  • Magnifier

    • Not available on all models

    • Provides better view of tympanic membrane, particularly for beginners


Features of the Otoscope

  • Speculum

    • Variety of sizes

    • Reusable or disposable


Overview of Otoscopic Assessment


Examination of the Ear

  • History

  • Observation

  • Palpation

  • Specialtests

    • Otoscopic assessment


Examination of the Ear

  • History

  • Trauma

  • Allergies, colds, sinus drainage

  • Changes in pressure (flying, diving)

  • Dizziness

  • Changes in hearing

  • Duration of symptoms


Examination of the Ear

  • Observation

  • Redness

  • Swelling

  • Drainage

  • Foreign object

  • Cuts, scrapes, bruises


Examination of the Ear

  • Palpation

  • Gentle pressure on tragus


Examination of the Ear

  • Palpation

  • Traction on ear lobe & pinna


Otoscopic Assessment

  • Evaluate the noninvolved ear first

  • This practice provides a basis for comparison AND prevents cross-contamination


Otoscopic Assessment

  • Step 1:

  • Place your patient in a seated position with his/her head turned slightly downward and away from the ear to be examined


Otoscopic Assessment

  • Step 1 (cont.):

  • I teach this as the “puppy position” (puppies always cock their heads to the side when you talk to them)


Otoscopic Assessment

  • Step 2:

  • Select the largest possible speculum that can be comfortably inserted into the ear


Otoscopic Assessment

  • Step 2 (cont.):

  • When inserted, the speculum should fit snugly in the outer third of the canal and rest against the tragus and anterior wall of the canal

Modified from Middle Ear Conditions. Anatomical Chart Co. Skokie, IL, 1999.


Otoscopic Assessment

  • Step 2 (cont.):

  • Choosing a speculum that is too small will cause movement within the canal

  • Excessive movement can cause discomfort for your patient

Modified from Middle Ear Conditions. Anatomical Chart Co. Skokie, IL, 1999.


Otoscopic Assessment

  • Step 3:

  • Hold the otoscope with the same hand as the ear you are examining

    • right ear, right hand

    • left ear, left hand


Otoscopic Assessment

  • Step 3 (cont.):

  • The otoscope should be stabilized by placing the ring and little finger resting on the patient’s cheek or temple


Otoscopic Assessment

Pencil Grip

Hammer Grip


Otoscopic Assessment

  • Step 4:

  • Pull the pinna upward and backward to straighten the canal

Modified from Middle Ear Conditions. Anatomical Chart Co. Skokie, IL, 1999.


Otoscopic Assessment

  • Step 5:

  • While maintaining traction on the pinna, place the speculum of the otoscope at, but not in the ear canal


Otoscopic Assessment

  • Caution:

  • Never insert the otoscope blindly

  • Always“Watch your way in”


Otoscopic Assessment

  • Tip:

  • If the patient experiences pain, reposition the canal by adjusting the angle and degree of traction on the pinna


Otoscopic Assessment

  • Caution:

  • If the patient’s discomfort persists even after readjustment of the canal, halt the examination and refer the patient to a physician.


Otoscopic Assessment

  • Step 6:

  • Once the tympanic membrane comes into view, rotate the speculum to view as much of the membrane as possible

  • Posterior superior

  • Anterior superior

  • Anterior inferior

  • Posterior inferior

Marty DR. The Ear Book. Jefferson City, MO: Lang ENT Publishing. 1987;Color plate 1.


Otoscopic Assessment

  • Tip

  • Like trying to view the corners of a room through a key hole

Marty DR. The Ear Book. Jefferson City, MO: Lang ENT Publishing. 1987;Color plate 1.

Modified from Middle Ear Conditions. Anatomical Chart Co. Skokie, IL, 1999.


Otoscopic Assessment

  • Tip

Fincher AL. Use of the otoscope in the evaluation of common injuries and illnesses of the ear. J Athl Train. 1994;29:53,54.

  • The posterior inferior portion of the membrane is often difficult to see

This is due to the angle of the membrane within the canal

Modified from Middle Ear Conditions. Anatomical Chart Co. Skokie, IL, 1999.


Otoscopic Assessment

  • Step 7:

  • Inspect the membrane for color, clarity, & position

    • Pearly gray

    • Semitransparent

    • Not bulging or retracted

L

R

Fincher AL. Use of the otoscope in the evaluation of common injuries and illnesses of the ear. J Athl Train. 1994;29:53,54.


Short process

Umbo

Otoscopic Assessment

  • Step 8:

    • Identify key landmarks

  • Malleus

  • Manubrium

  • Short process

  • Umbo

L

R

  • Light reflex

Fincher AL. Use of the otoscope in the evaluation of common injuries and illnesses of the ear. J Athl Train. 1994;29:53,54.


Otoscopic Assessment

  • Step 8 (cont.):

    • Identify key landmarks

  • Note that manubrium angles toward the 10:00 position in the left ear and the 2:00 position in the right ear

L

R

Fincher AL. Use of the otoscope in the evaluation of common injuries and illnesses of the ear. J Athl Train. 1994;29:53,54.


Pars flaccida

Pars tensa

Otoscopic Assessment

  • Step 8 (cont.):

    • Identify key landmarks

  • Pars flaccida

  • Pars tensa

L

R

  • Annulus

Fincher AL. Use of the otoscope in the evaluation of common injuries and illnesses of the ear. J Athl Train. 1994;29:53,54.


Otoscopic Assessment

  • Step 8 (cont.):

  • Identify key landmarks

    • Look beyond the membrane

      • Stapes

      • Incus

Fincher AL. Use of the otoscope in the evaluation of common injuries and illnesses of the ear. J Athl Train. 1994;29:53.


Otoscopic Assessment

  • Step 9:

    • Look for abnormalities

      • Fluid

      • Perforations

Fluid & Air Bubbles

Fincher AL. Use of the otoscope in the evaluation of common injuries andillnesses of the ear. J Athl Train. 1994;29:54.

Perforation

Marty DR. The Ear Book. Jefferson City, MO: Lang ENT Publishing. 1987;Color plate 8.


Otoscopic Assessment

  • Step 10

  • Work with your team physician to develop your confidence and skill

  • PRACTICE, PRACTICE, PRACTICE !!!

  • You must look at many ears to develop to become comfortable with “normal”


Guided, Self-Directed Activities – Post Lab

  • Content

    • Recognition of pathology – visual images

Perforation

Middle ear fluid

Marty DR. The Ear Book. Jefferson City, MO: Lang ENT Publishing. 1987;Color plate 8.

Marty DR. The Ear Book. Jefferson City, MO: Lang ENT Publishing. 1987;Color plate 3.


Guided, Self-Directed Activities – Post Lab

  • Content

    • Recognition of pathology – visual images

Perforation

Otitis Media

Modified from Middle Ear Conditions. Anatomical Chart Co., Skokie, IL. 1999.

Modified from Middle Ear Conditions. Anatomical Chart Co., Skokie, IL. 1999.


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