In examining the ear with a forehead mirror good illumination is necessary.
Any fairly powerful lamp, such as an electric bull's-eye lamp, will answer the
purpose. Daylight may suffice for the examination of the external meatus, but
is less satisfactory for the drumhead. The source of light is arranged on one
side of the patient's head and slightly above the level of his ear (Fig. 155). The
electric headlamp may be employed. The patient is seated sideways to the
surgeon who sits opposite the ear to be examined and reflects light on to it.
Before introducing a speculum the mastoid process should be examined, and
any abnormality, such as a scar, redness or oedema, is noted. The auricle is
Fig. 155. Otoscopic examination.
next examined for inflammation, swelling or skin lesions. The external
meatus is investigated for swelling of the walls, dermatitis or visible discharge,
and this inspection will allow a suitably sized speculum to be selected for
In order to see the drumhead the external meatus must be straightened by
pulling the auricle upwards, outwards and backwards. In infants, owing to the
non-development of the bony external meatus, the auricle has to be drawn