For otoscopy, ingenuity perfects technology

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!

Srinath Sanda, MD
Los Angeles, Calif.