The health care provider will dim the lights in the room. A young child will be asked to lie on his or her back with the head turned to the side. The child can also be held by an adult with the child's head resting against an adult's chest. Older children and adults may sit with the head tilted toward the shoulder opposite the ear being examined. The examiner's hand holding the otoscope will be securely braced against the side of the patient's head. The outer ear is grasped by the examiner's free hand and gently pulled up, back, or forward to help straighten the ear canal for better viewing. The ear speculum (a cone-shaped piece of the otoscope) is slowly inserted into the ear canal while looking into the otoscope. The speculum is angled slightly toward the patient's nose to follow the canal. The speculum is not inserted deeply. A light beam shines into the ear canal. The otoscope is gently moved to different angles to view the canal walls and eardrum. The view may be blocked by earwax. The otoscope may be equipped with a plastic bulb that introduces a tiny puff of air into the external ear canal (pneumatic otoscopy) to test if the ear drum has full mobility. Decreased mobility can mean that there is fluid in the middle ear space.
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