Fundamentals of Nursing Q 149
During an otoscopic examination, which action should be avoided to prevent the client from discomfort and injury?
A. Tipping the client's head away from the examiner and pulling the ear up and back.
B. Inserting the otoscope inferiorly into the distal portion of the external canal.
C. Inserting the otoscope superiorly into the proximal two-thirds of the external canal.
D. Bracing the examiner's hand against the client's head.
Correct Answer: C. Inserting the otoscope superiorly into the proximal two-thirds of the external canal.
In the superior position, the speculum of the otoscope is nearest the tympanic membrane, and the most sensitive portion of the external canal is the proximal two-thirds. It is important to avoid these structures during the examination. The provider should then slowly progress the speculum into the canal until the tympanic membrane becomes visible. The provider should evaluate the health of the tympanic membrane and observe factors such as color, presence of perforation, and a bulging appearance.
Option A: With the hand that is not holding the otoscope, the provider should grasp and gently pull the patient’s pinna to help straighten the patient’s external auditory canal. This step will facilitate visualization of the tympanic membrane. In a child, the examiner should pull the pinna posteriorly and inferiorly. In an adult, the examiner should pull the pinna posteriorly and superiorly.
Option B: During the otoscopic examination, the provider utilizes an otoscope, also known as an auriscope, to visualize the ear anatomy. While performing the otoscopic examination, the provider holds the handle of the otoscope and inserts the cone of the otoscope into the patient’s external auditory canal.
Option D: Providers may have their own preferences regarding how to grasp the otoscope. However, it is generally advisable to hold the otoscope like a pen in between the first and second fingers. The otoscope is usually held in the right hand when evaluating the patient’s right ear and the left hand when assessing the patient’s left ear. The provider should place their free fifth finger of the hand, holding the otoscope against the patient’s cheek to support and brace the hand during the examination.