Otoscopy: ear examination
PLAB 2 & PRES 3 · practical skills · medium · 8 minutes
Candidate brief
You are an FY2 doctor in a GP surgery. Daniel Kelly, 7, has been brought in by his mother with right ear pain and a temperature since last night. He is otherwise well and playing in the waiting room between bouts of crying with the pain. Please examine Daniel's ears with the otoscope, explain your findings to his mother, and agree a management plan. Verbalise your technique as you perform it.
What examiners look for
Brace, brace, brace. The otoscope hand rests against the patient's head so scope and head move as one unit. Every paediatric otoscopy injury comes from an unbraced hand meeting a moving child — and examiners for this station are watching the little finger of the scope hand, not the diagnosis. Normal ear first is a rule with three reasons: you learn what normal looks like in THIS patient, the child learns the examination doesn't hurt (on the ear that doesn't), and you don't carry infected material from a discharging ear into a healthy canal. Describe the drum like a dermatologist describes a rash: colour, position, surface, light reflex, integrity. "Red ear" is not a finding; a bulging, opaque, red tympanic membrane with a lost light reflex and an unwell febrile child is acute otitis media — while a red drum in a screaming, crying child with no bulge may just be a screaming, crying child. Pinna traction is age-dependent anatomy: up and back for adults and older children, down and back under three, because the canal's shape changes as the skull grows. Wrong traction kinks the canal and manufactures an "impossible" examination. Analgesia is the treatment; antibiotics are the exception. Most acute otitis media settles in around three days with regular paracetamol or ibuprofen alone. NICE guidance reserves immediate antibiotics for defined groups (systemically unwell, under-2s with bilateral infection, discharge/perforation, high complication risk) — a delayed/back-up prescription bridges the gap for many families. And complete the safety net: the complications worth naming to a parent are perforation (new discharge), mastoiditis (swelling behind the ear pushing it forward) and a child who is simply getting worse instead of better. Parents who know what to watch for use services better and worry less.
Guideline references
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