Content Map Terms

Home Ear Examination

Test Overview

A home ear examination is a visual inspection of the ear canal and eardrum using an instrument called an otoscope. An otoscope is a hand-held instrument with a light, a magnifying lens, and a funnel-shaped viewing piece with a narrow, pointed end called a speculum.

A home ear examination can help detect many ear problems, such as ear infections, excessive earwax, or an object in the ear canal.

After receiving instructions and training from a doctor, home ear examinations can be helpful for parents of young children who frequently get ear infections and earaches. Sometimes a child may have an ear infection in which the only outward symptom may be fussiness, a fever, or tugging at the ear. A home ear examination may help reveal the cause of these symptoms. But it can be hard to learn to use an otoscope, and some otoscopes are of poor quality. An examination with a doctor is often necessary.

Why It Is Done

A home ear examination may be done to:

  • Look for signs of infection when a person has an earache or when a young child has vague symptoms.
  • Check for a foreign object in the ear, such as an insect or a bean.
  • Check for earwax buildup when a person complains of hearing loss or of fullness or pressure in the ear.

How To Prepare

No special preparation is needed before having this test. Always remember to clean the ear speculum in hot, soapy water before using it.

How It Is Done

If you are going to examine a young child, have the child lie down with his or her head turned to the side, or have the child sit on an adult's lap and rest his or her head on the adult's chest. Older children or adults can sit with their head tilted slightly toward the opposite shoulder. Sitting is the best position for identifying otitis media with effusion (fluid behind the eardrum).

Select the largest viewing piece that will fit easily into the ear canal, and attach it to the otoscope.

If the person is only having problems with one ear, examining the other ear first may make it easier to determine what is different about the affected ear.

When checking the ear of a child older than 12 months or an adult, hold the otoscope in one hand and use your free hand to pull the outer ear gently up and back. This straightens the ear canal and improves visualization. In babies younger than 12 months, gently pull the outer ear down and back.

Now, slowly insert the pointed end of the viewing piece into the ear canal while looking into the otoscope. The sides of the ear canal can be quite sensitive, so try not to put pressure on the ear canal. It may help to steady your hand on the person's face so your hand moves along with their head in case they move quickly.

Do not move the otoscope forward without looking into it. Make sure you can see the path through the ear canal. You do not need to insert the viewing piece very far into the ear—the light extends well beyond the viewing tip.

Angle the tip of the viewing piece slightly toward the person's nose to follow the normal angle of the canal. While looking through the otoscope, move it gently at different angles so that you can see the canal walls and eardrum. Stop at any sign of increased pain. If your view is blocked by earwax, see the topic Earwax for tips.

Ask your doctor to review this technique with you and to watch you do an examination. Then practice on some healthy, willing adults so you can learn what a normal ear canal and eardrum look like. Don't be discouraged if you can't see the eardrum at first—it takes some practice and experience.

How It Feels

Examining a healthy ear using an otoscope is usually painless but may cause some mild discomfort if the person being examined has an ear infection.

Risks

The pointed end of the otoscope can irritate the lining of the ear canal. Make sure that you insert the otoscope slowly and carefully. If you do scrape the lining of the ear canal, it rarely causes bleeding or infection, but you must be careful to avoid pain or injury.

An otoscope can push an object closer to the eardrum. If you suspect an object in the ear, do not move the otoscope forward once you see the object. Don't try to remove the object—seek medical help.

There is a slight risk of damaging the eardrum if the otoscope is inserted too far into the ear canal. Do not move the otoscope forward if it feels like something is blocking it.

Results

A home ear examination is a visual inspection of the ear canal and eardrum using an instrument called an otoscope.

Ear canal

Normal:

  • Ear canals vary in size, shape, and colour.
  • The ear canal is skin-coloured and contains small hairs and usually some yellowish brown or reddish brown earwax.

Abnormal:

  • Wiggling or pulling on the outer ear causes pain.
  • The ear canal is red, tender, swollen, or filled with pus.
Eardrum

Normal:

  • The eardrum is pearly white or light gray, and you can see through it.
  • You can see the tiny bones of the middle ear pushing on the eardrum.
  • You see a cone of light, known as the "light reflex," reflecting off the surface of the eardrum. This cone of light is at the 5 o'clock position in the right ear and at the 7 o'clock position in the left ear.

Abnormal:

  • The light reflex on the eardrum is dull or absent
  • The eardrum is red and bulging.
  • You can often see amber liquid or bubbles behind the eardrum.
  • You can see a hole in the eardrum (perforation).
  • You can see whitish scars on the surface of the eardrum.
  • If your child has had a tube placed in an ear, you may also see the tiny plastic tube, which is usually blue or green.
  • The eardrum is blocked by earwax or an object, such as a bean or a bead.

If you see an inflamed canal, pus, a dull or red eardrum, fluid behind the eardrum, a hole in the eardrum, or a foreign object in the ear, call your doctor.

What Affects the Test

Reasons why the results of the test may not be helpful include:

  • Lying down while the ear is being examined. This can make it hard to detect the presence of a middle ear infection (otitis media) or fluid behind the eardrum (otitis media with effusion).
  • Crying. A small child who is upset or crying may have red eardrums. It is easy to confuse this redness with an ear infection.

What To Think About

  • Some home otoscopes use sound waves that bounce off the eardrum to detect otitis media with effusion (fluid in the middle ear).
  • Earwax (cerumen) is a normal protective secretion of the ear canal. Earwax normally drains by itself, and cleaning the outside of the ear is all that is necessary. Never clean your ear canals with cotton swabs, hairpins, paper clips, or your fingernail, which may damage the canal or eardrum and can push the wax farther into the canal. For information on how to remove earwax, see the topic Earwax.

Regardless of what you see with a otoscope, call your doctor if you or your child has:

  • Severe ear pain, especially if your child has a fever.
  • Sudden hearing loss.
  • Dizziness.
  • An inability to move the muscles on one side of the face (facial nerve paralysis).
  • Persistent ringing in one or both ears.
  • Drainage from one or both ears.

References

Other Works Consulted

  • Committee on Practice and Ambulatory Medicine, Bright Futures Periodicity Schedule Workgroup (2014). 2014 recommendations for pediatric preventive health care. Pediatrics, published online February 24, 2014. DOI: 10.1542/peds.2013–4096. Accessed March 7, 2014.

Credits

Current as of:
April 15, 2020

Author: Healthwise Staff
Medical Review:
Susan C. Kim MD - Pediatrics
Thomas M. Bailey MD - Family Medicine
Kathleen Romito MD - Family Medicine
Charles M. Myer III MD - Otolaryngology