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. 

Do you have a Clinical Tip to share with colleagues? Let us know; we'll pay $50 for each item accepted for publication. Tips sent by mail should be addressed to Clinical Tips Editor, 

,5 Paragon Drive, Montvale, NJ 07645-1742. If you send by e-mail 