Ear Examination

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Test Overview

An ear exam is a thorough check of the ears. It is done to screen for ear problems, such as hearing loss, ear pain, discharge, lumps, or objects in the ear. An ear exam can find problems in the ear canal, eardrum, and middle ear. These problems may include infection, too much earwax, or an object like a bean or a bead.

During an ear exam, a tool called an otoscope is used to look at the outer ear canal and eardrum. An otoscope is a handheld tool with a light and a magnifying lens. It also has 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. The air helps the doctor to see how the eardrum moves.

Why It Is Done

An ear exam may be done:

  • As part of a routine physical exam.
  • To screen babies and children for hearing loss.
  • To find 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 just be in the external ear canal (otitis externa). Or it might be in the middle ear behind the eardrum (otitis media).
  • To see how the treatment for an ear problem is working.

How To Prepare

It is important to sit very still during an ear exam. A young child should be lying down with his or her head turned to the side. Or the child may sit on an adult's lap 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 exam can be done in a doctor's office, a school, or the workplace.

For an ear exam, the doctor uses a special tool called an otoscope to look into the ear canal and see the eardrum.

Your doctor will gently pull the ear back and slightly up to straighten the ear canal. For a baby under 12 months, 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 the ear and gently move the speculum through the middle of the 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. It also shows how well the eardrum moves when the pressure inside the ear canal changes. It helps the doctor see 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 exam of the ear using an otoscope usually isn't painful. If you have an ear infection, putting the otoscope into the ear canal may cause mild pain.

Risks

The pointed end of the otoscope can irritate the lining of the ear canal. This can often be avoided by putting the otoscope in slowly and carefully. If the otoscope does scrape the lining of the ear canal, it could cause bleeding or infection, but this is rare.

Results

An ear exam is a thorough check of the ears. It is done to look for ear problems, such as ear pain, discharge, lumps, or objects in the ear.

Results of an ear exam
Normal:
  • 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 be seen.
  • The eardrum moves slightly when a puff of air is blown into the ear.
Abnormal:
  • Touching, wiggling, or pulling on the outer ear causes pain.
  • 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.
  • 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

You may not be able to have the test, or the results may not be helpful, if:

  • Earwax, dirt, or an object such as a bean or a bead is hiding or blocking the eardrum in the ear canal. Your doctor may need to clean the ear canal before looking in the ear.
  • The child is upset or crying, causing red eardrums. This redness may be confused with an ear infection.
  • The child can't sit still during the exam.

What To Think About

  • Other types of tests may be used to check the ear and hearing. These tests include:
    • Acoustic immittance testing. This 2-minute to 3-minute test measures how well the middle ear relays sound. The soft tip of a small tool is put into the ear canal and adjusted to make a tight seal. Sound and air pressure are then sent toward the eardrum. The test is not painful, but you might feel slight changes in pressure or may hear the tone.
    • Vestibular tests. These tests can look for 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 doing other movements with your eyes open and closed. The person giving the test will make sure that you don't fall.
    • MRI and CT scan. One or both of these tests may be done to examine the inner ear or to prepare for a surgery such as cochlear implant.
  • 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.

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

ByHealthwise Staff

Primary Medical ReviewerSusan C. Kim, MD - Pediatrics

E. Gregory Thompson, MD - Internal Medicine

Specialist Medical ReviewerCharles M. Myer, III, MD - Otolaryngology

Current as ofMay 4, 2017

Current as of: May 4, 2017

Author: Healthwise Staff

Medical Review: Susan C. Kim, MD - Pediatrics & E. Gregory Thompson, MD - Internal Medicine & Charles M. Myer, III, MD - Otolaryngology