Physical Exam

Otoscopy

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Video coming September 2026

How to Perform

Choose the largest speculum that fits comfortably and tip the patient's head slightly toward the opposite shoulder. Straighten the ear canal by pulling the auricle up, back, and slightly out in an adult (down and back in a young child). Holding the otoscope braced against the cheek, insert the speculum gently under direct vision and examine the canal and the tympanic membrane — its color, contour, landmarks (the cone of light and handle of the malleus), and any perforation. Pneumatic otoscopy assesses drum mobility with a puff of air.

How to Interpret

Acute Otitis Media

Bulging tympanic membrane on otoscopy in a child

Rule in

Very helpful

Rule out

—

Evidence:Limited

Cloudy (opacified) tympanic membrane on otoscopy in a child

Rule in

Very helpful

Rule out

—

Evidence:Limited

Distinctly impaired tympanic membrane mobility on pneumatic otoscopy in a child

Rule in

Very helpful

Rule out

—

Evidence:Limited

Otitis Media with Effusion

Reduced tympanic membrane mobility on pneumatic otoscopy in a child

Rule in

Somewhat helpful

Rule out

Very helpful

Evidence:Strong

References

Rothman R, Owens T, Simel DL. Does this child have acute otitis media? JAMA. 2003;290(12):1633-1640. doi:10.1001/jama.290.12.1633. PMID: 14506123. Free DARE summary at NCBI Bookshelf NBK70308. With primary-study reference: Karma PH, Penttilä MA, Sipilä MM, Kataja MJ. Otoscopic diagnosis of middle ear effusion in acute and non-acute otitis media. Int J Pediatr Otorhinolaryngol. 1989;17(1):37-49.
Rothman R, Owens T, Simel DL. Does this child have acute otitis media? JAMA. 2003;290(12):1633-1640. doi:10.1001/jama.290.12.1633. PMID: 14506123. Free DARE summary at NCBI Bookshelf NBK70308.
Takata GS, Chan LS, Morphew T, Mangione-Smith R, Morton SC, Shekelle P. Evidence assessment of the accuracy of methods of diagnosing middle ear effusion in children with otitis media with effusion. Pediatrics. 2003;112(6 Pt 1):1379-1387. doi:10.1542/peds.112.6.1379. PMID: 14654613. Free DARE summary at NCBI Bookshelf NBK70068. Endorsed by AAO-HNS/AAP/AAFP Otitis Media with Effusion Clinical Practice Guidelines (2004, updated 2016).
Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.