The health care provider will dim the lights in the room. A young child will be asked to lie on his or her back with the head turned to the side. The child can also be held by an adult with the child's head resting against an adult's chest. Older children and adults may sit with the head tilted toward the shoulder opposite the ear being examined.

The examiner's hand holding the otoscope will be securely braced against the side of the patient's head. The outer ear is grasped by the examiner's free hand and gently pulled up, back, or forward to help straighten the ear canal for better viewing. The ear speculum (a cone-shaped piece of the otoscope) is slowly inserted into the ear canal while looking into the otoscope.

The speculum is angled slightly toward the patient's nose to follow the canal. The speculum is not inserted deeply. A light beam shines into the ear canal. The otoscope is gently moved to different angles to view the canal walls and eardrum. The view may be blocked by earwax.

The otoscope may be equipped with a plastic bulb that introduces a tiny puff of air into the external ear canal (pneumatic otoscopy) to test if the ear drum has full mobility. Decreased mobility can mean that there is fluid in the middle ear space.

No preparation is needed for this test.

If an infection is present, there may be some discomfort or pain. The test will be stopped if there is an increase in pain.

Examining the ear can reveal the cause of symptoms such as an earache, the ear feeling full, or hearing loss. In young children, the only symptoms of an ear infection may be tugging at the ear, crankiness, or fever. Examining the ear is a useful means of monitoring the effectiveness of treatments for some ear problems.

The ear canal varies in size, shape, and color. Normally the canal is skin-colored and has small hairs. Earwax may be present, which is a yellowish-brown color. The ear drum is a light-gray color or a glistening pearly-white. The small bones of the middle ear usually are pushing on the eardrum membrane like tent poles. A cone of light (light reflex) should be seen reflecting off the eardrum surface.

Ear infections are a common problem, especially with small children. Middle ear infections may be present if the light reflex is dull or absent. The eardrum may be red and bulging. Amber liquid or bubbles behind the eardrum are often seen if fluids collect in the middle ear.

An external ear infection may be present if the ear canal is red, tender, swollen, painful when wiggling or pulling on the outer ear, or if the canal is filled with yellowish-green pus.

Additional conditions under which the test may be performed:

• cholesteatoma
• external ear infection - chronic
• ruptured or perforated eardrum

If the ear speculum is not disinfected, an infection can be spread from one ear to the other.

Not all ear problems can be detected by looking through an otoscope. Additional ear and hearing tests may be needed.

In the case of otoscopes designed for use in the home, they are lower quality than the ones providers use, and parents may not be able to recognize some of the subtle signs of an ear problem. If symptoms of severe ear pain, hearing loss, dizziness, fever, ringing in the ears, or ear discharge or bleeding are present, see the health care provider.

Earwax is a normal protective secretion of the ear canal. It is not dangerous and should not be removed by putting an object into the ear. There are several products available at drugstores that dissolve or soften the earwax so that it may be flushed out gently with warm water.