Otology
Examination of the ear • The auricle,external auditory canal and the postaural region are thoroughly inspected for the shape and size of the auricle,color changes in the skin,swelling,ulcer or a previous operative scar
Methods of examination of the ear • Conventional approach • Otoscopy • Examination with siegel's speculum • Examination under microscope
• Conventional approach • The inside of the external canal is examined conveniently using a head mirror,light source and an ear speculum
• Otoscopy The otoscope gives some magnification and is useful in examination children and infants,and for bedside examination of the patients,but any manipulation with an instrument while using the otoscope is impossible
• Examination with siegel's speculum This speculum consists of a 10 diopter lens and a side tube connected with a rubber bulb.An air tight system is produced in the canal and pressure in increased in the bulb. The speculum is helpful for the following reasons. • 1.It gives a magnified view of the membrane. • 2.It is helpful to assess the mobility of the membrane. • 3.The speculum is used to elicit the fistula sign. • 4.By varying the pressure,discharge through the perforation can be sucked out as well as medication can be put into the middle ear. •
• Examination under microscope • For better and detailed examination of the middle ear cleft,examination under microscope is of great help
Examination of the eustachian tube • Examination of eustachian tube function,and thus of middle-ear pressure,is an important part of the examination of the ear. • Valsalva's Test The patient keeps the nostrils tightly pinched and attempts to blowout; air enters the eustachian tube.The eardrum is seen to move,and a click is often heard. The test is useful to know the mobility of the eardrum as well as the patency of the eustachian tube. This test may normally be negative
• Politzerzation Polizer's method consists of applying the olive of a Polizer bag firmly to one nostril and pinching the other side.The patient blows the cheeks and the bag is suddenly pressed to force air up the eustachian tube.The outward movement of the eardrum indicates a patent eustachian tube