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Using an Auroscope

Approach to patient

  • Introduce yourself
  • Confirm patient identity
  • Explain the procedure 
  • Obtain consent
  • Wash your hands and make sure all equipment required is close by
  • Ensure patient is in a seated in a comfortable position at a 90 degree angle to you




    • Examine the good ear first
    • Inspect and palpate the pinna for tenderness, swelling and local disease (eg. Basal cell or squamous cell carcinomas, haematoma, cellulitis, eczema-sign of otitis externa)
    • Switch on the auroscope and use the light to inspect behind the ear (for surgical scars and as above).
    Tympanic membrane (


    • Attach the largest clean speculum that will comfortably fit into the ear canal, to the auroscope
    • Use a different speculum for each ear (to avoid cross-contamination if infection is present)
    • Using the right hand to inspect the right ear and vice versa, hold the handle like a pen proximal to the eye piece (see image)
    • Rest the ulnar aspect of the hand gently on the patient's face, with the patient's face turned slightly away from you. This stabilises the hand and reduces the risk of trauma to the ear (see image)
    • To help with the entry of the speculum, straighten the external auditory meatus by gently lifting the pinna up and backward (for young children lift backwards only, this is due to the anatomy of the canal being straighter in children) 
    • Insert speculum gently and inspect the external auditory canal noting: cerumen, colour, lesions, discharge or foreign bodies
    • Inspect the whole tympanic membrane by moving the auroscope around carefully: normally it should appear to be a pearly grey colour
    • Locate the malleus handle, work up towards parsa flaccida, going around the edge of tympanic membrane, parsa tensa and finally inspecting the pars flaccida. Note:
    1. Presence of intact/perforated tympanic membrane
    2. Colour (pearly grey normally , gold blue indicates fluid in middle ear, whitish in tympanosclerosis)
    3. Translucency (translucent normally, opaque)
    4. Shape (concave normally, bulging or retracted)
    5. Light reflex (present normally in anterior-inferior quadrant of membrane, absent in perforation)
        Using auroscope (

        Common observations

        Normal tympanic membrane Acute middle ear infection with effusion ( Wax ( Serous otitis media ( Fluid behind the eardrum ( Schwartze sign-Otosclerosis ( Tympanosclerosis ( Grommet ( Perforation (
        1. Normal tympanic membrane
        2. Acute otitis media (middle ear infection) with effusion - an inflamed bulging tympanic membrane with an obscured handle of malleus.
        3. Wax, or cerumen in the meatus. The more denser it is, the more darker colour it becomes.
        4. Serous otitis media- retraction of ear drum with handle of the malleus lying horizontally
        5. Fluid behind the eardrum- visible effusion in the lower half of ear drum
        6. The Schwartze sign (Active Otosclerosis)- a pink flush behind the promontory
        7. Tympanosclerosis- formation of calcified plaques on tympanic membrane, due to otitis media
        8. Grommet – tympanostomy tube for persistent middle ear effusion
        9. Tympanic membrane perforation associated with acute infection and pus discharge





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