What Is Pneumatic Otoscopy?
A pneumatic otoscopy is used to evaluate the eardrum or tympanic membrane. It is most commonly used to diagnose otitis media (middle ear infection).
Along with that, it helps in evaluating the movement of the eardrum in response to changes in pressure. In a healthy ear, the eardrum moves about the pressure in the ear. Immobility of the eardrum can be caused by various reasons, which include -
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If the ear is filled with fluid.
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Perforation in the tympanic membrane or eardrum.
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Tympanosclerosis (scarring of the eardrum).
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Infection of the middle ear.
What Is the Mechanism of Hearing in the Human Ear?
A pneumatic otoscopy is a valuable tool in diagnosing middle ear disorders. The human ear is categorized into three sections, each serving a different purpose. The three sections of the human ear are the outer, middle, and inner.
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The sound is collected by the outer ear (pinna and ear canal) and directed toward the eardrum, making it vibrate.
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The vibrations are boosted and are sent to the inner ear through the middle ear.
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The vibration is converted into electrical impulses by the inner ear (cochlea), from where it is sent to the brain.
What Is the Purpose of an Otoscope?
Pneumatic otoscopy helps evaluate the negative and positive pressure in the middle ear and helps in determining the tympanic membrane mobility. This procedure involves systemic evaluation of the external ear canal and tympanic membrane with an otoscope. The major advantage of this instrument is that It is widely used and readily available.
What Are the Parts of This Device?
Otoscopes with pneumatic tubes are used to visualize the ear canal and eardrums with the help of a charged bright bulb.
Pneumatic otoscopy requires -
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Pneumatic otoscope.
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Ear specula that provide a tight seal with the ear canal.
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An insufflator bulb.
1. Pneumatic Otoscope - It looks like a small hammer with a handle and otoscope on the top to view the inner ear. The batteries are present in the handle, which may be rechargeable. However, before usage, the otoscope must be fully charged or supplied with fresh batteries and bulbs (halogen or xenon bulbs).
2. Ear Specula - These are funnel-shaped plastic structures attached to the otoscope, which are inserted into the ear.
The ear specula are available in different sizes, and various types of specula include -
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Reusable ear specula - 2.5 mm, 3 mm, 4 mm, and 5 mm.
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Single-use ear specula - 2.75 mm and 4.25 mm.
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SofSpec reusable specula include a soft tip specially contoured for a pneumatic seal - 3 mm, 5 mm, and 7 mm.
3. Insufflator Bulb - The insufflator bulb is the additional attachment that is attached tightly to the head of the otoscope to avoid the loss of an air seal.
What Are the Benefits of Pneumatic Otoscopy?
The benefits of pneumatic otoscopy include the following -
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This is one of the best diagnostic tools to evaluate ear disorders.
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It is quick and painless.
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It is easy to perform.
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These are inexpensive and readily available.
What Is the Procedure of Pneumatic Otoscopy?
This procedure is best performed in a bright room, with a patient on the examination table. The basic steps involved in this procedure include -
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First, the tip of the otoscope is inserted into the ear canal, ensuring a strong seal is made with the ear canal. Rubber tubing can be used to make a proper seal with ear canal specula.
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After that, the healthcare provider can visualize the tympanic membrane and mark landmarks such as the malleus (a hammer-like small bone in the middle ear that connects with the incus and inner surface of the tympanic membrane) and the cone light reflex (a visible phenomenon that occurs on viewing tympanic membrane with an otoscope).
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Retraction of the tympanic membrane can be checked by noting the position of the lateral process of the malleus.
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Tympanic membrane mobility can be assessed by gently squeezing and releasing the rubber bulb. If there is no fluid present, the membrane will move briskly, and if fluid is present, mobility will be hindered.
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Another method can also be used in which the bulb is squeezed before the insertion of the specula and released once the seal is made.
In the case of children, the following steps have to be followed to evaluate the ear using an otoscope -
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The head and body of the child should be immobilized. This can be best done by seating the child in the lap of the parent.
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The parent has to restrain the child by placing one hand on the forehead and holding the side of the head against the chest, and with the other arm, the body and both arms are restrained.
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It may be helpful to show the otoscope to the children and hold it to reassure them that it would not cause any pain.
What Is the Diagnostic Application of Pneumatic Otoscopy?
The pneumatic otoscopy can help in diagnosing various conditions such as -
1. Otitis Media with Effusion (OME) - It is defined as a collection of fluid in the middle ear. The fluid may accumulate in the middle ear due to a sore throat and upper respiratory infection.
2. Acute Otitis Media - A middle ear infection caused by viruses and bacteria. Diagnosing acute otitis media can be quite challenging, especially for young children. The diagnostic criteria include rapid onset of symptoms and signs of middle ear inflammation and effusion. While pneumatic otoscopy helps detect inflammation, erythema, bulging of the tympanic membrane, and reduced movement of the tympanic membrane, pneumatic otoscopy is the key to diagnosing a middle ear effusion.
3. Tympanic Membrane Retraction - When negative pressure is created in the middle ear, the tympanic membrane gets retracted and is usually flaccid and hypermobile. The immobility of the membrane can be assessed. Moreover, the movement of the tympanic membrane can be exaggerated when negative pressure is applied, which can be done by releasing the bulb instead of compressing it. This helps check the mobility of the tympanic membrane and differentiate the retraction of the membrane with a large perforation (hole).
4. Hennebert’s Sign or Fistula Test - Pneumatic otoscopy can be done to diagnose a fistula and the root cause of repeated vertigo (a sudden sensation that makes a person feel that everything around them is moving).
5. Brown’s Sign - In some cases, the otoscopic examination of the middle ear may reveal a reddish-blue pulsatile mass behind an intact tympanic membrane. During the test, the positive pressure causes the mass to blanch, referred to as Brown’s sign.
What Are the Risks Associated With a Pneumatic Otoscopy?
The pneumatic otoscopy is a simple and common procedure that does not involve risks. However, some of the less common complications associated with otoscopy include the following -
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Ossicular Discontinuity - Loss of alignment between the three middle ear bones due to the otoscope.
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Sensorineural Deafness - Loss of hearing due to the injury to the inner ear or the nerve connecting the ear to the brain.
Conclusion:
Pneumatic otoscopy is a prevalent and accessible method to diagnose various ear disorders. It is easy to perform procedures and requires less armamentarium. This is a beneficial procedure in evaluating the tympanic membrane and infection of the middle ear. Moreover, the non-invasive nature of pneumatic otoscopy makes it a particularly attractive choice, especially when examining pediatric patients who may be apprehensive about more invasive procedures. Its ability to distinguish between fluid-filled and normal middle ear conditions aids in timely diagnosis and appropriate treatment, potentially preventing complications and discomfort.
