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How do you perform a pneumatic Otoscopy?

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The physician performs a pneumatic otoscopy using a special tool, otoscope, in the following manner:
The physician performs a pneumatic otoscopy using a special tool, otoscope, in the following manner:
  • The patient must sit still during the procedure. During the examination of a child, the parent must hold the child on their lap.
  • The doctor gently pulls the ear backward and upward to straighten the ear canal and get a better view of the eardrum.
  • The tip of an otoscope is then inserted into the ear canal, ensuring that a strong seal is made with the canal.
  • The ear canal and eardrum are checked and cerumen (excess earwax), if any, is removed.
  • The eardrum is assessed for color, translucency, and position. A normal ear canal is convex, translucent, and intact. The bulb on the otoscope is squeezed and released alternately create positive and negative pressure on the eardrum and assess its mobility.
  • Absence of eardrum mobility on the application of slight positive and negative pressure indicates an infection.

This procedure may cause a temporary hole in the eardrum that would heal spontaneously.

What is a pneumatic otoscopy?

Pneumatic otoscopy is an ear examination that assesses eardrum movement in response to pressure changes. A healthy eardrum moves in response to pressure. Immobility may be due to:

  • Fluid in the ear
  • Perforation (hole)
  • Tympanosclerosis (scarring of the eardrum)
  • Middle ear infections

Advantages of a pneumatic otoscopy include:

  • High sensitivity and specificity to identify a middle ear infection
  • Better than other ear examination methods
  • Cheaper than other methods
  • Easy to perform with appropriate training
  • Quick and painless tests
  • Otoscopes are widely available

A pneumatic otoscopy provides a useful means to examine diseases in the middle ear.

  • Our ear has three parts. Each part has an important function:
  • The outer ear (pinna and ear canal) gathers and directs sound, causing the eardrum to vibrate.
  • The middle ear (tympanic membrane, ossicles, mastoid, and eustachian tube) augments and passes the vibrations to the inner ear.
  • The inner ear (cochlea) transforms the vibration into electrical signals and drives them to the brain.

For a pneumatic otoscopy, you require the following:

  • Pneumatic otoscopes: These are instruments used to visualize the ear canal and eardrums. Otoscopes must be fully charged with a bright bulb.
  • Ear specula: These are funnel-shaped pieces of plastic attached to an otoscope. An ear speculum is inserted into the ear canal.
  • Insufflator bulbs: These are attached tightly to the head of an otoscope by means of a tube.

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When is a pneumatic otoscopy indicated?

A pneumatic otoscopy is useful to diagnose the following conditions:

  • Acute otitis media (a painful type of ear infection)
  • Otitis media with effusion (collection of thick fluid behind the eardrum)
  • Tympanic membrane retraction (retraction of the eardrum)
  • Hennebert’s sign or fistula test (a test done to identify the root cause of repeated vertigo)
  • Brown’s sign (a test done to reveal a reddish-bluish pulsatile mass behind the eardrum)

What are the complications of a pneumatic otoscopy?

You might experience slight discomfort during the procedure. Some of the less common complications of pneumatic otoscopy include:

  • Ossicular discontinuity: It is the loss of normal alignment between the three middle ear bones.
  • Sensorineural deafness: It is hearing loss caused by damage to the inner ear or the nerve from the ear to the brain.
References
https://emedicine.medscape.com/article/1348950-overview#a9

https://open.umich.edu/sites/default/files/downloads/pneumaticotoscopyandotoscopy.pdf

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