Clinical Tip: Ear exams: Watch the light. Listen for the "shhh"

When it comes to getting children to let you check their ears, you can never have enough tricks up your sleeve. Before looking into the child's ear, I shine the otoscope light onto the patient's hand or leg, my ear, or the parent's ear, then move the light close and far away several times while repeating, "see the circle and now the doughnut." This trick works well, especially for autistic children, who I've found like repetition. One of my autistic patients likes the trick so much that he now asks anyone who looks in his ears to do it.

I also have a collection of characters who "live" in kids' ears (Elmo and Barbie, for example). I tell children I need to see the character, but I have to be very quiet about it, so I say, "shhhhh" in a very soothing tone while I look in the ear. I am amazed at how many patients have suddenly stopped doing whatever they were doing to pay attention to the "shhhh."

Moneesha Narula-Isaac, MD Canton, Mass.