An ear examination is a thorough evaluation
of the ears that is done to screen for ear problems, such as
hearing loss, ear pain, discharge, lumps, or objects in the ear. An ear
examination can detect problems in the ear canal, eardrum, and the middle ear,
earwax, or an object like a bean or a bead.
During an ear examination, an instrument called an
otoscope is used to look at the outer ear canal and
eardrum. An otoscope is a handheld instrument with a light, a magnifying lens,
and a funnel-shaped viewing piece with a narrow, pointed end called a speculum.
A pneumatic otoscope has a rubber bulb that your doctor can
squeeze to give a puff of air into the ear canal. This allows the doctor to see how the eardrum moves.
Why It Is Done
An ear examination may be done:
As part of a routine physical
To screen babies and children for hearing
To determine the cause of symptoms such as earache, a feeling
of pressure or fullness in the ear, or hearing loss.
To check for
excess wax buildup or an object in the ear canal.
To find the
location of an ear infection. The infection may involve only the external ear
canal (otitis externa) or the middle ear behind the eardrum
To monitor the effectiveness of treatment for an
How To Prepare
It is important to sit very still
during an ear examination. A young child should be lying down with his or her
head turned to the side or sitting on the lap of an adult with the child's head
resting securely on the adult's chest. Older children and adults can sit with
the head tilted slightly toward the opposite shoulder.
Your doctor may need to remove earwax in order to see the eardrum.
How It Is Done
An ear examination can be done in a
doctor's office, a school, or the workplace.
ear examination, the doctor uses a special instrument called an
otoscope to look into the ear canal and see the eardrum.
doctor will gently pull your ear back and slightly up to
straighten the ear canal. If a baby under 12 months is being examined, the ear
will be pulled downward and out to straighten the ear canal. The doctor will then insert the pointed end (speculum) of the otoscope into
your ear and gently move the speculum through the middle of your ear canal to
avoid irritating the canal lining. The doctor will look at each
eardrum (tympanic membrane).
Using a pneumatic otoscope lets your
doctor see what the eardrum looks like and how well it moves when
the pressure inside the ear canal is changed. And it helps the doctor
determine if there is a problem with the
eustachian tube or fluid behind the eardrum (otitis media with effusion). A normal eardrum will
flex inward and outward in response to the changes in pressure.
How It Feels
The physical examination of the ear using
an otoscope is usually painless. If you have an ear infection, inserting the
otoscope into the ear canal may cause some pain or mild discomfort.
The pointed end of the otoscope can irritate the
lining of the ear canal, but this can usually be avoided by inserting the
otoscope slowly and carefully. If the otoscope does scrape the lining of the
ear canal, this rarely causes bleeding or infection.
An ear examination is a thorough
evaluation of the
ears that is done to screen for ear problems, such as
ear pain, discharge, lumps, or objects in the ear.
Results of an ear examination
Ear canals vary in size, shape, and color.
The ear canal is skin-colored and lined with small
hairs and usually some yellowish brown earwax.
The eardrum is normally pearly white or light gray,
and you can see through it.
Also, one of the tiny bones in the middle ear can
The eardrum moves slightly when a puff of air is
blown into the ear.
Touching, wiggling, or pulling on your outer ear
The ear canal is red, tender, swollen, or filled with
yellowish green pus.
The eardrum is red and bulging or looks dull and
slightly pulled inward (retracted).
Yellow, gray, or amber liquid or bubbles are seen
behind the eardrum.
There is a hole in the eardrum (perforation) or
whitish scars on the surface of the drum.
The eardrum does not move as it should when a puff of
air is blown into the ear.
What Affects the Test
Reasons you may not be able to
have the test or why the results may not be helpful include:
Earwax, dirt, or an object such as a bean or a
bead hiding or blocking the eardrum (tympanic membrane) in the ear canal. Your
doctor may need to clean the ear canal before examining the
Crying. A small child who is upset or crying may have red
eardrums. This redness may be confused with an ear infection.
inability of some children to sit still during the examination.
What To Think About
Other types of tests may be used to examine the
ear and evaluate hearing. These tests include:
Acoustic immittance testing (tympanometry
and acoustic reflex testing). This 2-minute to 3-minute test measures how well
the middle ear relays sound. The soft tip of a small instrument is inserted
into the ear canal and adjusted to achieve a tight seal. Sound and air pressure
are then directed toward the eardrum. The test is not painful, but slight
changes in pressure may be felt or the tone may be
Vestibular tests (falling and past-pointing tests). These
tests can detect problems with areas of the inner ear that help control balance
and coordination. During these tests, you will try to maintain your balance and
coordination while moving your arms and legs in certain ways, standing on one
foot, standing heel-to-toe, and performing other maneuvers with your eyes open
and closed. Your health professional will make sure that you do not
If your child has repeat ear infections, your
doctor may suggest that you buy a simple otoscope that is
available for home use. To learn more, see the topic
Home Ear Examination.
Other Works Consulted
American Academy of Pediatrics (2008). Recommendations
for preventive pediatric health care. In Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents,
3rd ed., p. 591. Elk Grove Village, IL: American Academy of Pediatrics. Also
How this information was developed to help you make better health decisions.