Holding Child for Examination of the Ear

equipment

cleaning ear

tympanic membrane
(with practice exercises)

How to hold and examine a child

Young children are comfortable and feel secure sitting on the parent's lap. We don't use a wall mounted otoscope, so we can examine children while the parent is sitting comfortably anywhere in the room, including next to the writing desk. Otherwise we would have to move the parent and child closer to the wall unit, or to the exam table, which allows too much free movement. If the parent steadies the child's hands, they won't so easily grab at your instruments. When the child is held against the parent's chest, the child's head is steady.

Often you can use your free left hand to turn the child's head to the right (in this photo, examining the left ear) so that head movement is limited. Notice in the photo, the pneumatic bulb is cradled in the 4th and 5th fingers of the physician's right hand. This frees up his left hand to assist with the head, if necessary.

When inserting the speculum, view the canal as you insert. If wax is present, avoid continuing to insert further, so as not to shove the wax further into the ear canal. Remove the cerumen before proceeding with the exam. (See: How to clean the ear for additional instructions.)

Push partway on the pneumatic bulb before inserting, so you can either exert a negative pressure or a positive pressure when you have a seal, depending upon the appearance of the tympanic membrane. Notice that in the photo, the physician is supporting the otoscope with the 2nd and third fingers of his right hand, which are placed against the child's cheek. If the child moves suddenly, his entire hand and scope will move, preventing trauma to the ear canal from the speculum.

Here the physician cradles the bulb in the web space between his thumb and index finger.

This is another very comfortable method to hold the otoscope while freeing up your other hand to pull back on the ear pinna or to steady the child's head.

We frequently use the examining table and headlight with binocular to remove cerumen from the ear canal. Usually an assistant holds the head. The parent can steady the hands and feet from the other side of the table.

A towel around the forehead can help comfort the child's head and make the head less slippery for the assistant to hold.

The binocular permits a magnified view of the ear canal, which is under excellent illumination from the bright light.

Prisms focus your binocular view directly down the ear canal, allowing for an excellent three dimensional view of the tympanic membrane after the cerumen has been removed.