Early Childhood

You may feel as if you need 10 hands and a bag of tricks to examine the ear of toddlers and young children, who are sensitive to examining the ear canal and drum and fearful because they cannot observe the procedure. With a little practice you can master this technique. Unfortunately, many young children will need to be briefly restrained during this part of the examination, which is why you may want to leave it for the end.

If the child is not too fearful, you may be able to do the examination while the child is sitting on his parent's lap. It is helpful to make a game out of the otoscopic examination, such as finding an imaginary object in the child's ear, or talking playfully throughout the examination to allay any fears. It is sometimes helpful to place the otoscopic speculum gently into the external auditory canal of one ear and then withdraw it to have the child get used to the procedure, before performing the actual examination. Ask the parent for a preference regarding the positioning of the child for the examination.

There are two common positions—the child lying down and restrained, and the child sitting in the parent's lap. If the child is being held supine, have the parent hold the arms either extended or close to the sides to limit motions. You can hold the head and retract the tragus with one hand while you hold the otoscope with your other hand. If the child is on the parent's lap, the child's legs should be between the parent's legs. The parent could help with gentle restraint by placing one arm around the child's body and a second arm to steady the head.

Many students have difficulty even visualizing a child's tympanic membrane. In young children, the external auditory canal is directed upward and backward from the outside, and the auricle must be pulled upward, outward, and backward to afford the best view. Hold the child's head with one hand (your left hand if you are right-handed), and with that same hand pull up on the auricle. With your other hand, position the otoscope.

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