Do-it-yourself ear lookin’

The Pediatric Insider

© 2009 Roy Benaroch, MD

Michelle wanted to know if it would be a good idea for her to get her own otoscope to look in her kids’ ears. Like many parents, she has found it frustrating to not know whether an ear infection was brewing, and was wondering if she could take a peek herself to get some idea of whether a doctor visit was necessary.

Home otoscopy is probably not a good idea for everyone. It’s not easy to look in there, and even residents I train often don’t have a good eye for what they see. Ear infections are both easy to over-diagnose and easy to under-diagnose if you’re inexperienced. Your pediatrician might take a 1 second peek, but that 1 second is backed up by looking at  least a thousand other ears. In a squirming or waxy child, knowing what you’re looking at gets even more difficult.

If you’d like to give it a try, start by getting good equipment. The “home versions” sold at drug stores are worthless, with inadequate magnification and anemic, yellow lights. There’s also a home scope marketed specifically to moms—it’s pretty much worthless, from the ones I’ve seen moms bringing in. You need a good instrument with good optics and a solid white bright light. Every doc I know uses instruments from Welch Allyn. Try ebay, and make sure you’re buying a set with a handle, batteries, an otoscope “head”, and speculae. You don’t need the newer “panoptic” head. I replace the bulbs in the ones I use at least once a year, but they probably last longer with less frequent use.

It helps if your child is calm and comfortable, and reasonably free of wax. If the ear canal is waxy, do not try to scrape it out—leave that for the pediatrician to do.

Look at images and drawings of eardrums, so you have some idea of what you ought to see. Examine normal ears (yours, your neighbors, your spouse’s….) as often as you can—don’t wait until your child has symptoms to take a first peek. If you’re not sure what a normal eardrum looks like, there’s no point in even trying to look at an infected one.

Not all ear pain is caused by middle ear infections (“otitis media”). Kids with swimmer’s ear (“otitis externa”) will complain bitterly of pain, but their eardrums look normal. Their ear canals, though, will be red and swollen and often clogged with debris. Sticking an otoscope in there to peek may be very painful.

Rather than trying to learn to use an otoscope, you might want to look into a device that electronically detects fluid in the middle ear space, like this one. It’s easy to use, and helps at least “rule out” ear infections—if there is no fluid, there’s no infection. I’ve found that this device is very accurate when it shows a “green”—meaning no infection. It does sometimes overcall an ear as possibly infected. Still, it’s fairly inexpensive and safe, and might save you a few copays. This device won’t work if your child has ear tubes, has small ear canals, or is less than about 12 months of age.

Next week: removing your own appendix!

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