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Clinic @10

OTOSCOPIC SIEGELIZATION

As discussed in the previous post,most of the Otoscopes nowadays have a Siegel's attachment

USES of  Siegelization

(A) DIAGNOSTIC

1) Magnification..2X

2) To assess the Mobility of the TM

3) To perform FISTULA TEST

(B) THERAPEUTIC

1) To perform aural toilet

2) To insufflate medication..usually Antibiotic powder

3) To break the synechiae between TM and Promontory in the early stages.

Clinic @9

EAR EXAMINATION WITH AN OTOSCOPE

When examining with an Otoscope, one may note

1) The Otoscope should be held like a pen.

2) The Otoscope should be held in the hand which side the ear is to be examined i.e. RIGHT for RIGHT and LEFT for LEFT.

3) While examining, the Ring finger and the Little finger of the hand holding the scope should rest on the cheek of the patient to ensure that there is NO inadvertent trauma ( to the Ear).

4) The other hand pulls the pinna to ensure straightening of the pinna.

ADVANTAGE/S

1)Self contained source of illumination..

2) Magnification ..2X (some newer models have more.

3) Facility for Siegeization.

DISADVANTAGE/S

1)Runs on dry battery cells..hence illumination over a period of time will decrease.

2) Uniocular vision....hence compromise of DEPTH OF FIELD.

Clinic @8

EAR EXAMINATION WITH SPECULUM

When one examines WITH a speculum,it may  be noted 

1) One should use the largest possible speculum so that the TM may be seen in one single position.

2) The speculum should be introduced in a gentle screwing movement so that there is NO VASOVAGAL STIMULATION...

Clinic @7

 EAR EXAMINATION WITHOUT SPECULUM

It may be noted 

1) The use of right hand here to pull the pinna is WRONG...it could have potentially obstructed the path of light.

2) The direction in which the pinna is pulled.....UPWARD,OUTWARD and BACKWARD ensures that the EAC is straightened for satisfactory examination of the TM. 

Clinic @6

Certain pertinent points to discuss taking benefit of  the above image 

1) The OPD setup ( Bull's Eye Lamp and Head Mirror)should be such that the source of illumination (the Bull's Eye Lamp here) and the reflector (the head mirror here) should be close to each other.......so with a RIGHT HANDED examiner, the mirror should be on the right eye of the examiner...for subtle adjustment/s of the mirror can be made with the dominant hand and accordingly the Bull's lamp should also be on the right side of the EXAMINER....behind the LEFT shoulder of the patient....one needs to remember here that the orientation of the patient and the examiner are opposite i.e. the EXAMINER'S RIGHT is the PATIENT'S LEFT and vice versa.. 

2) Initially, the examiner should make a honest and fervent attempt to examine WITHOUT instrument/s and WITHOUT magnification..

3) While performing examination, care has to be taken that the examiners' hand/s or intrument/s SHOULD NOT obstruct the path of illumination and vision. 

P.S. Admit this post is too verbose....henceforth will try to be brief .

Clinic @5

EXAMINATION...
How?

Conventional OPD Examination setup encompasses 

1) Bull's Eye Lamp

2) Head Mirror

This setup ensures 

a) CONSISTENT and CONCENTRATED illumination.

b) BINOCULAR vision.

Binocular vision is EXTREMELY MANDATORY for perception of DEPTH OF FIELD, the significance of which can't be underestimated after per viewing the following images...