I've noticed that many toddlers find otoscopic examination distressing, in part because of the surprise of the speculum entering the ear canal. Just before I insert the otoscope in a toddler's ear, I speak softly in that ear. Then, as I pull back the external ear with my free hand, I use the thumb of that hand to gently depress the tragus, providing a subtle lead-in to insertion of the speculum. This doesn't get me 100% compliance, but it helps a lot by eliminating the surprise factor.
Andy Bernstein, MDEvanston, Ill.
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