b. Ear Canal and Eardrum (Tympanic Membrane (TM)). The eardrum may
need to be cleaned before you can examine it properly.
(1) Cleaning the eardrum. If the eardrum needs to be cleaned, clean under
direct observation. The eardrum can be cleaned with a cerumen spoon #8. Only a
skilled professional should do such cleaning. Irrigation with a softening agent such as
Debrox, Cerumenex, or water is another method of cleaning the ear drum. DO NOT
jab blindly with a cotton-tipped applicator; this may result in puncture of the tympanic
membrane or packed cerumen.
Examining the ear canal and eardrum. Follow this procedure:
(a) Attach a speculum to the otoscope. (An otoscope is the instrument
commonly used to examine the ear.) Use the largest diameter instrument earpiece that
will fit the ear canal without causing the patient discomfort.
(b) Hold the otoscope in either of these two ways. Hold the instrument
right side up with your fingers between the otoscope handle and the patient's head. Or,
hold the instrument upside down with your finger and the ulnar surface of your hand
against the patient's head.
(c) Tip the patient's head away from you and straighten the ear canal
by pulling the auricle up and back slightly.
(d) Gently insert the tip of the otoscope into the ear canal.
(e) Inspect the ear canal for cerumen, redness, swelling, foreign
bodies, and scaling.
(f) Locate the eardrum. (It is the pearly, translucent membrane.)
Inspect it for color (pearly) and shape (non-bulging).
c. Hearing. Test for auditory acuity.
(1) Whisper numbers at a distance of one foot. Have the patient repeat the
numbers after you. If the patient cannot hear a whisper at a distance of one foot, he
probably has about a 30 decibel hearing loss.
(2) Hold a ticking watch next to one ear. Note the closest distance at which
the patient can hear the watch tick.