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for which assessment would you use an otoscope with a pneumatic attachment

by Dr. Eunice Senger II Published 2 years ago Updated 1 year ago

Full Answer

How is a pneumatic otoscope used to diagnose tympanic membrane perforation?

The pneumatic otoscope may also be useful in distinguishing between a thin atrophic intact tympanic membrane adherent to the medial wall of the middle ear, which can be made to move, and a large perforation, which will not move.

What is pneumatic otoscopy?

Pneumatic otoscopy, especially when used with the operating microscope, facilitates identification of fluid in the middle ear. Pneumatic otoscopy, which is a relatively simple procedure, can yield important information about middle ear pressure.

What is an otoscope exam?

Nursing, Allied Health, and Interprofessional Team Interventions The otoscope exam helps to assess the condition of the external auditory canal (EAC), tympanic membrane (TM), and the middle ear.   Mastering the otoscope exam leads to accurate diagnoses, allowing for targeted treatment and prevention of complications.

How do you use an otoscope correctly?

Gently pull the ear backward to straighten the ear canal and get a better view of the tympanic membrane. Insert the otoscope far enough to create a good seal; this prevents air leakage between the speculum and ear canal wall. Take care not to insert the device too deeply. Inspect the ear canal and eardrum.

What is pneumatic otoscopy?

How to check middle ear pressure?

How often is AOM misdiagnosed?

What does abnormal movement mean in the middle ear?

What is the strongest predictor of AOM?

How does the tympanic membrane move?

What are the landmarks of the middle ear?

See 4 more

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Pneumatic otoscopy | definition of pneumatic otoscopy by Medical dictionary

pneumatic otoscopy: inspection of the ear with a device capable of varying air pressure against the tympanic membrane. Imparting movement to the tympanic membrane suggests normal middle ear compliance; the lack of movement indicates either increased impedance, as with fluid in the middle ear, or perforation of the tympanic membrane.

Pneumatic Otoscope Examination - Medscape

Pneumatic otoscopy is an examination that allows determination of the mobility of a patient’s tympanic membrane (TM) in response to pressure changes. The normal tympanic membrane moves in response to pressure.

Pneumatic otoscopy - Wikipedia

The pneumatic otoscope is the standard tool used in diagnosing otitis media.In addition to the pneumatic (diagnostic) head, a surgical head also is useful. The pneumatic head contains a lens, an enclosed light source, and a nipple for attachment of a rubber bulb and tubing.

Chronic Ear Pain: It’s Not All in Your Head, Part I

Chronic ear pressure, pain, or discomfort can be extremely frustrating. This is especially true when there is no clear cause found by your doctor. Usually this will result in treatment for an ear infection (otitis media or otitis externa) inappropriately and unsuccessfully.

Why is pneumatic otoscopy important?

[ 3] Therefore, pneumatic otoscopy is important, as it can indicate the presence of effusion even when the appearance of the eardrum otherwise gives no indication of middle ear pathology. Pneumatic otoscopy has been found to have a high sensitivity and specificity for diagnosing middle ear effusion. [ 4, 5, 6, 7] It has also been shown to do as well as or better than tympanometry and acoustic reflectometry, and it is especially useful in a setting in which tympanometry is not readily available. [ 8] Other advantages are that it is cheap and easy to perform with appropriate training.

What should a clinician do if unable to achieve a proper fit for an airtight seal?

If unable to achieve a proper fit for an airtight seal, the clinician should reposition his or her arm to change the angle of the speculum.

How to hold the Siegle speculum?

Hold the Siegle speculum with the first and second fingers. Place the third finger in the concha and the fourth finger behind the ear to provide retraction. See image below.

What is the tympanic membrane?

The tympanic membrane (TM) is an oval, thin, semi-transparent membrane that separates the external and middle ear (tympanic cavity). The TM is divided into 2 parts: the pars flaccida and the pars tensa. The manubrium of the malleus is firmly attached to the medial tympanic membrane; where the manubrium draws the TM medially, a concavity is formed.

Which fingers are holding the Siegle speculum?

Correct hand positioning for using the Siegle speculum. The first and second fingers are holding the speculum while the third and fourth fingers are in the concha and behind the ear, respectively, to provide retraction.

What is the function of the middle ear?

The primary functionality of the middle ear (tympanic cavity) is that of bony conduction of sound via transference of sound waves in the air collected by the auricle to the fluid of the inner ear. The middle ear inhabits the petrous portion of the temporal bone and is filled with air secondary to communication with the nasopharynx via the auditory (eustachian) tube.

Is anesthesia necessary for pneumatic otoscopy?

No anesthesia is necessary in routine pneumatic otoscopy, and its use is discouraged.

Why is otoscopy important for otitis media?

A normal TM will respond by concaving into the middle ear cavity. The most common cause of decreased TM mobility is middle ear effusion. Therefore, pneumatic otoscopy aids in the diagnosis of acute o titis media (AOM) and otitis media with effusion (OME). Recent clinical practice guidelines report that AOM should not receive a diagnosis without evidence of middle ear effusion shown by pneumatic otoscopy. Other causes of decreased TM mobility are tympanosclerosis, TM retraction, and TM perforation. [8][9][10][11][12][13]

What are the items that are examined in the EAC?

Examiners inspect the EAC for cerumen impaction, foreign objects, canal edema, erythema, and otorrhea.

What is MOE in otoscope?

MOE, severe sequelae of OE, is an invasive infection of the EAC and skull base. Early diagnosis is critical; therefore, MOE should be a consideration with any patient with refractory OE, fever above 39 C, diabetes mellitus, or immunosuppression. On the otoscope exam, granulation tissue is visible along the floor of the EAC at the bony-cartilaginous junction (i.e., isthmus). Cranial nerve exams are warranted when evaluating for MOE. Spread to the stylomastoid foramen can present with facial nerve palsy. Spread to the jugular foramen can present with glossopharyngeal, vagus, or accessory nerve palsies. MRI and CT (without contrast) scans are useful in diagnosis, with CT being more sensitive for bone erosion. The mainstay treatment for MOE is culture-sensitive long-term antibiotic therapy, and in some cases, surgical debridement. [27][28][29]

How to inspect the right ear?

To inspect the right ear, the examiner holds the otoscope with their right hand and the ear with his left. The otoscope is held with three fingers, like a pen, between the thumb, first, and second fingers. The fifth finger rests on the patient's head to stabilize the otoscope. The EAC travels in a “sigmoid” fashion; therefore, the recommendation is to manipulate the pinna to allow for proper visualization of the TM. For adults and older children, the pinna is gently retracted in a posterior and cephalad vector. For neonates, the examiner pulls the pinna posteriorly and inferiorly. It is essential to use a fully charged otoscope, as low light may produce a yellow tint on the TM, which is subject to misinterpretation as middle ear effusion. [4][3][5]

What is AOM in children?

AOM is defined as an infection of fluid accumulated in the middle ear. It is primarily a pediatric diagnosis since most cases occur in patients 6 to 24 months of age, and decrease with advancing age so long as the patient has normal palatal muscle function. The most reliable symptom seen in AOM patients is otalgia, and up to two-thirds of patients present with fever. However, patients, especially children, can present with non-specific symptoms such as tugging on the affected ear, irritability, headache, poor sleep, poor feeding, vomiting, and diarrhea. Otoscopic examination is indicated with all children presenting with upper respiratory infection symptoms. [16][17]

What is OE in ear?

OE is defined as an infection or inflammation of the ear canal. It has a 10% lifetime prevalence, 90% of cases are unilateral, and the majority of cases are in adults. There is a strong association with high humidity, higher temperature, swimming, local trauma to the ear canal, hearing aid use, and history of diabetes mellitus. The hallmark symptom is otalgia, primarily associated with pinna manipulation. Pruritus is a common precursor symptom. Patients also complain of ear fullness and hearing loss secondary to canal edema and debris accumulation. Otoscope findings include ear canal edema and erythema with thick seropurulent otorrhea, which can be malodorous. Audiologic testing can help rule out middle ear involvement.

What is OME in pediatrics?

OME is defined as accumulated fluid in the middle ear space without evidence of inflammation or infection. OME is a common pediatric presentation, with an incidence of 20% in children. The combination of clinical signs and findings on the otoscope exam gives the diagnosis. The most common presenting symptoms are ear fullness and conductive hearing loss. On the otoscope exam, the TM will look opacified with a loss of a light reflex. Retraction of TM and decreased mobility are also common findings. Unlike in AOM, bulging of the TM is not typical. Most cases of OME are self-limiting. Antibiotics, oral decongestants, or intranasal corticosteroids are not effective treatment options. [22][23][24][21]

What is pneumatic otoscopy?

Pneumatic otoscopy provides practitioners with a simple method for determining tympanic mobility and helps then recognize many middle ear disorders.

What is the purpose of otoscope?

Use of a well-designed otoscope which provides illumination, magnification and air pressure capability for checking tympanic membrane mobility is, therefore, essential, allowing the practitioner to view the ear canal and, in particular, the tympanic membrane with clarity.

Where is a tympanostomy tube inserted?

A tympanostomy tube is often inserted into the tympanic membrane to ventilate the middle ear in cases of chronic serous otitis media. These tubes come in a variety of sizes, shapes and materials. The tympanostomy tube should be seen to be in place in the tympanic membrane with its lumen patent and free of any exudate or debris.

What is the most important diagnostic tool available to the practitioner for determining whether the ear is the source of the patient?

The otoscope, when used correctly, is the single most important diagnostic tool available to the practitioner for determining whether the ear is the source of the patient’s complaint. Otoscopy is one of the primary methods a practitioner uses for diagnosing patient complaints for the entire ear-nose-throat complex.

How to check for ear infection?

1. Carefully inspect the pinna and postauri cular skin. Gently palpate the pinna to determine if any tenderness exists. 2. Inspect the entrance to the ear canal for debris or pus, which might interfere with further examination. 3. Choose the largest speculum that can comfortably be inserted into the ear canal.

Why is it important to have a clinical examination of the ear?

Since symptoms of ear disease are relatively few in number and frequently nonspecific, a clinical examination of the ear is important in the management of ear disorders. When a patient complains of ear pain, examination of the ear is indicated to differentiate whether the patient’s disorder is an ear infection or a disorder originating in adjacent ...

Can you hold the bulb of an otoscope in the same hand?

You can hold the bulb of the pneumatic attachment in the palm of the same hand. If the patient turns or moves, the otoscope will move in unison with the patient’s head. This will avoid possible injury to the ear canal or even the tympanic membrane.

What is an otoscope?

This article has been viewed 33,736 times. An otoscope is a medical instrument used by a doctor to examine the ear. The otoscope magnifies the inside of the ear to detect problems or issues with the outer and middle ears, such as Swimmers ear, earwax build-up, or otitis media. It generally has a magnifying glass, ...

How to hold otoscope?

Handle the otoscope properly. Turn the otoscope’s light on and hold your otoscope “upside down” between your thumb and pointer finger like a pen or pencil. Place the back of your hand along the person’s cheek so that otoscope is steady and braced. While the position may feel awkward at first, it soon will feel natural.

What to ask a patient about pressure?

Ask your patient if the pressure is acceptable to them. For example, “Is the pressure I’m using ok, Mr. Neumaier? Let me know if you have any discomfort.”

Where to insert otoscope?

Insert the otoscope slowly into the ear canal. Place the otoscope at your patients ear, not in it. [6]

Can you use an otoscope with caution?

Use caution with an otoscope. Your doctor is trained in proper techniques and can minimize the risk of injury from improper use.

Is the content of this article intended to be a substitute for professional medical advice, examination, diagnosis, or treatment?

The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. You should always contact your doctor or other qualified healthcare professional before starting, changing, or stopping any kind of health treatment.

Can otoscope bump the inner canal wall?

Avoid putting too much pressure on the otoscope, which can bump the inner canal wall, causing the patient discomfort.

Which surface of the hand is best for assessing temperature?

The ulnar surface of the hand and bases of the fingers can best feel vibratory sensations such as thrills and fremitus. The dorsal surface of the hand is best for assessing temperature. The finger pads and fingertips are best for palpating pulses. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 33.

What is the first technique used in an examination?

Inspection, the process of systematic observation, is the first technique used in an examination. Light palpation is used after inspection. The order for examination is usually inspection, palpation, percussion, and then auscultation. Deep palpation is used after inspection.

What is inspection in medical?

Inspection is the technique that is used while gathering and validating data during both the history taking and the actual hands-on physical examination. Auscultation, palpation, and percussion are not used during the history taking and physical examination processes. It is not possible to listen to the patient talking and use the stethoscope at the same time. The focus is on the patient's response to your touch and what you are feeling; it is not possible to perform palpation and listen to the patient talking at the same time.

How is the degree of percussion tone determined?

The degree of percussion tone is determined by the density of the medium through which the sound waves travel. Which statement is true regarding the relationship between density of the medium and percussion tone?

Which position is best for auscultation of low pitched heart sounds?

The left lateral recumbent position places the left ventricle closer to the chest wall and is recommended for auscultating low-pitched sounds, such as the third and fourth heart sounds. If the patient is in the prone, dorsal recumbent, or right Sims position, you will not be able to auscultate heart sounds.

Which is louder, percussion or medium?

a.The more dense the medium, the louder is the percussion tone.

When to use a mask?

Use of masks and eye protection or a face mask is indicated during procedures that are likely to generate splashes or sprays of body fluids , which include endotracheal secretions. During tube feedings, patient bathing, and wet to dry dressing changes, there is no splashing of body fluids.

What is pneumatic otoscopy?

Pneumatic otoscopy, especially when used with the operating microscope, facilitates identification of fluid in the middle ear.

How to check middle ear pressure?

Remember the example of the plastic wrap and the effect of changes in middle ear pressure? Now imagine that the pressure changes are imposed from the other side of the membrane (i.e., from the external auditory canal). To perform this procedure, use an otoscope with a pneumatic bulb attachment (it is best to carry your own) and a special speculum with an expanded tip that forms an airtight seal in the external canal without the application of pressure. As an alternative, a small piece of rubber tubing placed over the tip of a standard spe culum provides an excellent seal. Look through the otoscope while squeezing and releasing the rubber bulb ( Fig. 7-6 ).

How often is AOM misdiagnosed?

It has been estimated that AOM is misdiagnosed up to 50% of the time. This results in unnecessary exposure of children to antibiotics and potentiates the development of resistant organisms. Therefore it is essential for physicians to have a consistent approach for making the diagnosis of AOM. The diagnosis is contingent on both symptoms identified by history and clinical signs identified by a thorough physical examination, including pneumatic otoscopy. Children may present with a recent history of fever and acute onset of irritability (infants and toddlers) or ear pain (older children). Other associated symptoms include cough and rhinorrhea.

What does abnormal movement mean in the middle ear?

Abnormal movements indicate abnormal pressures in the middle ear.

What is the strongest predictor of AOM?

The strongest positive predictor of AOM is a bulging tympanic membrane that obliterates normal landmarks, followed by the finding of reduced mobility and then an opaque tympanic membrane. 50 Redness alone is the least predictive because of the potential for false-positive results that can occur when the child cries.

How does the tympanic membrane move?

The normal tympanic membrane moves medially (away from you) when you apply external pressure by squeezing and moves laterally (toward you) when you create negative pressure by releasing the bulb. If middle ear pressure is already significantly negative and the eardrum is retracted medially, this pneumatic maneuver may produce only slight lateral motion of the drum when the bulb is released. If the middle ear pressure is abnormally positive, you may produce only slight medial movement when you apply positive pressure. If the pressure changes are significant, the drum may be immobile. Experience brings an appreciation of the nuances of these changes. As with every other aspect of the examination, you must see many eardrums move before you can recognize slightly reduced mobility.

What are the landmarks of the middle ear?

The middle ear landmarks include the short process and manubrium (or handle) of the malleus, which are in contact with the eardrum, and the chorda tympani nerve and incudostapedial joint posterosuperiorly, which are deep or medial to the TM but are usually visible through the eardrum ( Fig. 5-3 ).

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