Pneumatic otoscopy is an essential skill for all pediatricians. Published guidelines stress that acute otitis media should be diagnosed only when fluid is observed in the middle ear. Sometimes, however, I find it difficult to obtain a good seal around the external auditory canal so that I can view tympanic membrane mobility clearly. Furthermore, most disposable speculums on hand in emergency rooms or the pediatrician's office lack the rubber bulb at the tip to make a good seal possible.
In a pinch, you can use paper tape to make an effective seal (see photos). Tear off a 4-inch strip of tape from a standard 1-inch-wide roll of paper tape. Next, tear or cut the strip in half lengthwise. Wrap one strip around the speculum about 0.5 to 1 cm from the tip. Now you have a comfortable ear speculum with a seal that makes visualizing tympanic membrane mobility easy. (Later, you can use the other half of the tape for another speculum tip.)
One final word: Remember to use your insufflators!