9
Table 3. Practical Tips for Performing Pneumatic Otoscopy
Pneumatic Otoscopy Tip Rationale
Aer attaching the speculum
to the otoscope, squeeze the
pneumatic bulb fully, then firmly
cover the tip of the speculum with
your finger and let go of the bulb.
e bulb should stay compressed aer blocking
the speculum if there are no air leaks. If the bulb
opens (e.g., the pressure is released), check the
speculum for a tight fit and the bulb and tubing
for leaks.
Choose a speculum that is slightly
wider than the ear canal to obtain
an air-tight seal.
A speculum that is too narrow cannot form a
proper seal and will give false-positive results.
Before inserting the speculum
squeeze the pneumatic bulb
halfway (about 50% of the bulb
width), then insert it into the
canal.
Squeezing the bulb first allows the examiner to
apply both negative pressure (by releasing the
bulb) and positive pressure (by further squeezing ).
Insert the speculum deep enough
into the ear canal to obtain an
air-tight seal, but not deep enough
to cause pain.
Limiting insertion to the cartilaginous (outer)
portion of the ear canal is painless, but deep
insertion that touches the bony ear canal and
periosteum can be very painful.
Examine tympanic membrane
mobility by squeezing and
releasing the bulb very slightly and
very gently several times.
Many children have negative pressure in their
middle ear space, so both positive (squeezing the
bulb) and negative (releasing the bulb) pressure
are needed to fully assess mobility. Using slight
and gentle pressure will avoid unnecessary pain.
Diagnose OME when movement
of the tympanic membrane is
sluggish dampened, or restricted;
complete absence of mobility is
not required.
When OME is absent the tympanic membrane
will move briskly with minimal pressure. Motion
is reduced substantially with OME, but with
enough pressure some motion is almost always
possible.
Table 4. Risk Factors for Developmental Difficulties in
Children With Otitis Media with Effusion
a
• Permanent hearing loss independent of otitis media with effusion
• Suspected or confirmed speech and language delay or disorder
• Autism-spectrum disorder and other pervasive developmental disorders
• Syndromes (e.g., Down) or craniofacial disorders that include cognitive, speech, or
language delays
• Blindness or uncorrectable visual impairment
• Cleft palate, with or without associated syndrome
• Developmental delay
a
Sensory, physical, cognitive, or behavioral factors that place children who have otitis media with
effusion at increased risk for developmental difficulties (delay or disorder)
