General Ear Examination Guidelines
- Otoscope technique:
- Hold with three fingers
- Use two fingers to stabilize on the patient’s face
- Pull ear upwards and backwards
- Rest two fingers on cheek while examining
- Right hand can be used for both ears, but left hand is better for left ear
- For left ear examination:
- Hold otoscope in left hand
- Stabilize two fingers on patient’s cheek
- This provides better stability and prevents trauma if patient moves
- Tuning fork:
- Not used in earwax scenarios
- For children or uncooperative patients:
- Always stabilize fingers on the cheek to prevent trauma if the patient moves
- Explanation: “If the patient moves, the whole system will move, preventing potential injury”
Important Points to Remember
- Antibiotics for otitis media:
- Don’t give if symptoms are present for less than 5 days
- Give if otorrhea (ear discharge) is present
- Paracetamol dosage for children with otitis media:
- Every 4 hours
- Not more than 4 doses in 24 hours
- Earwax treatment:
- Medicated ear drops (almond or olive oil-based)
- 3 drops, 2 times a day, for 3 weeks (3-2-3 rule)
- Sudden hearing loss protocol:
- Same-day referral for audiometry and ENT if cause is unknown
- MRI to rule out acoustic neuroma
- Tympanic membrane perforation:
- Most heal on their own
- Refer to ENT specialist for assessment and possible treatment
- Ear irrigation:
- Not recommended as first-line treatment for earwax
- Now done privately, patient needs to pay
- Risks include perforation and irritation of the ear canal
- Hearing loss is taken very seriously in the UK healthcare system