Otoscope Advice

Parents keep asking me if they should get an otoscope. As in, “if I had an otoscope, I wouldn’t be here.”

Seriously….visualizing the ear drum is a pain in the patoot. You would think the baby would sit perfectly still while you stick a big black scary plastic cone in her ear. You’d think you’d look in the tiny little hole and see this huge eardrum like the pretty book pictures. You’d think it’d be completely obvious if the ear is red because your patient is screaming her teeny eyebrows off, or because it’s horribly infected. (oh, and btw, you’re supposed to grab this itty bitty bulb, attach it to the scope, and squeeze it to blow air against the eardrum to watch the movement so you can decide if there’s fluid behind it–while the child is screeching so loud she’s frightening the other parents–if you don’t know what that redness is from.) Maybe the eardrum is perforated and all you see is pus (but HEY, so easy! Infected but ruptured! Sounds awful but easy to fix! I have samples! Here’s the drops! Parent happy! MD happy! Love all around!) But usually, if the child has a cold, there’s some fluid behind there. Maybe not pus, but some fluid. Infected or not? And the wax! Good God, I know it’s supposed to help clean out the ear canal and all, but….just, WOW. NOT HELPFUL. Then try to clean out the wax on the screaming, clawing, arching 18 month old who weighs 30 lbs with your hard plastic pointy stick…But really, I love my job!

So, anyway, the classic healthy ear drum is translucent, grey, has a bright light reflex, and a lovely view of those little ear bones that I can never remember the order of….(hey, I’m not an ENT, okay. I know their names are stapes, malleus, and…..and….shush a minute while I google….INCUS! I knew it all along). No sick kid looks like that. Fever+runny nose+cough=irritability=screaming=red. And red does NOT mean infected, unfortunately. So basically it comes down to this: in the 30 seconds that I might take to hold down and torture your child by sticking something hard and scrapey into her delicate ear canal while she shakes her head wildly and I try desperately to see the window that should be her eardrum, I have to decide if what I’m looking at is:

normal,

normal with nasty, red, goopy ear canal (external ear infxn/swimmer’s ear),

normal but red from crying,

red with little bit of clear fluid behind it (doesn’t need antibiotics),

red with pus behind it (usually gets antibiotics, but probably doesn’t need them if over 2 years),

has blisters all over it (bullous myringitis—hurts like heck, gets antibiotics),

has some funky growth behind it (cholesteotoma—goes to friendly, wealthy ENT),

or is ruptured (easy! Yay! See above!).

So sure, get an otoscope. I wish you well. Please don’t cause permanent damage.

On the other hand, they do market acoustic reflectometers for parents and I think those are great! Takes 2 seconds and tells you (essentially, hush up fellow science geeks) if the eardrum moves or not. If it doesn’t move, probable fluid, go see doctor, likelihood of actual infection a little higher. But if it does move, it’s normal! Skip doctor!

Well. ummm. maybe? Okay, I think it’s a very helpful device for the parent who’s freaking out at the ear pulling that might just be teething, but not so much for the high fever, hacking out a lung kid, because maybe she has pneumonia and you should go see your doctor anyway. They also run about $50—or two copays-ish.

So that’s my take on parent otoscopes. Love you! See how I’m not expecting any corporate sponsorships any time soon? I’m all about the parents!

2 thoughts on “Otoscope Advice

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    Deana Reply

    There have been some dads wondering if they could use their dremel to fill Little Johnny's tooth but I usually try to dissuade them 😉 .

    Gilbert Trujillo, DDS

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