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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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Presentation Transcript
objectives
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 of otoscopes
Types of Otoscopes
  • Pocket style
    • < $50
  • Clinical model
    • $200 - $400+

Pocket style

Clinical model

features of the otoscope
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 otoscope1
Features of the Otoscope
  • Magnifier
    • Not available on all models
    • Provides better view of tympanic membrane, particularly for beginners
features of the otoscope2
Features of the Otoscope
  • Speculum
    • Variety of sizes
    • Reusable or disposable
examination of the ear
Examination of the Ear
  • History
  • Observation
  • Palpation
  • Specialtests
    • Otoscopic assessment
examination of the ear1
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 ear2
Examination of the Ear
  • Observation
  • Redness
  • Swelling
  • Drainage
  • Foreign object
  • Cuts, scrapes, bruises
examination of the ear3
Examination of the Ear
  • Palpation
  • Gentle pressure on tragus
examination of the ear4
Examination of the Ear
  • Palpation
  • Traction on ear lobe & pinna
otoscopic assessment
Otoscopic Assessment
  • Evaluate the noninvolved ear first
  • This practice provides a basis for comparison AND prevents cross-contamination
otoscopic assessment1
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 assessment2
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 assessment3
Otoscopic Assessment
  • Step 2:
  • Select the largest possible speculum that can be comfortably inserted into the ear
otoscopic assessment4
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 assessment5
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 assessment6
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 assessment7
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 assessment8
Otoscopic Assessment

Pencil Grip

Hammer Grip

otoscopic assessment9
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 assessment10
Otoscopic Assessment
  • Step 5:
  • While maintaining traction on the pinna, place the speculum of the otoscope at, but not in the ear canal
otoscopic assessment11
Otoscopic Assessment
  • Caution:
  • Never insert the otoscope blindly
  • Always“Watch your way in”
otoscopic assessment12
Otoscopic Assessment
  • Tip:
  • If the patient experiences pain, reposition the canal by adjusting the angle and degree of traction on the pinna
otoscopic assessment13
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 assessment14
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 assessment15
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 assessment16
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 assessment17
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.

otoscopic assessment18
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 assessment19
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.

otoscopic assessment20
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 assessment21
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 assessment22
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 assessment23
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
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 lab1
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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