Test Overview

A home ear examination is a visual
inspection of the
ear canal and eardrum using an instrument called an
otoscope. An otoscope is a handheld instrument with a
light, a magnifying lens, and a funnel-shaped viewing piece with a narrow,
pointed end called a speculum.

A home ear examination can help
detect many ear problems, such as
ear infections, excessive
earwax, or an object in the ear canal.

After receiving instructions and training from a doctor,
home ear examinations can be helpful for parents of young children who
frequently get ear infections and earaches. Sometimes a child may have an ear
infection in which the only outward symptom may be fussiness, a fever, or
tugging at the ear. A home ear examination may help reveal the cause of these
symptoms. But it can be hard to learn to use an otoscope, and some otoscopes are of poor quality. An examination
with a doctor is often necessary.

Why It Is Done

A home ear examination may be done

  • Look for signs of infection when a person has
    an earache or when a young child has vague symptoms.
  • Check for a
    foreign object in the ear, such as an insect or a bean.
  • Check for
    earwax buildup when a person complains of hearing loss or of fullness or
    pressure in the ear.

How To Prepare

No special preparation is needed
before having this test. Always remember to clean the ear speculum in hot,
soapy water before using it.

How It Is Done

If you are going to examine a young
child, have the child lie down with his or her head turned to the side, or have
the child sit on an adult’s lap and rest his or her head on the adult’s chest.
Older children or adults can sit with their head tilted slightly toward the
opposite shoulder. Sitting is the best position for identifying otitis media with effusion (fluid behind the eardrum).

Select the
largest viewing piece that will fit easily into the ear canal, and attach it to
the otoscope.

If the person is only having problems with one ear,
examining the other ear first may make it easier to determine what is different
about the affected ear.

When checking the ear of a child older
than 12 months or an adult, hold the otoscope in one hand and use your free
hand to pull the outer ear gently up and back. This straightens the ear canal
and improves visualization. In babies younger than 12 months, gently pull the
outer ear down and back.

Now, slowly
insert the pointed end of the viewing piece into the ear canal while looking
into the otoscope. The sides of the ear canal can be quite sensitive, so try
not to put pressure on the ear canal. It may help to steady your hand on the
person’s face so your hand moves along with their head in case they move

Do not move the otoscope forward without looking into
it. Make sure you can see the path through the ear canal. You do not need to
insert the viewing piece very far into the ear-the light extends well beyond
the viewing tip.

Angle the tip of the viewing piece slightly
toward the person’s nose to follow the normal angle of the canal. While looking
through the otoscope, move it gently at different angles so that you can see
the canal walls and eardrum. Stop at any sign of increased pain. If your view
is blocked by earwax, see the topic Earwax for tips.

Ask your doctor to review this technique with you and to watch you do an
examination. Then practice on some healthy, willing adults so you can learn
what a normal ear canal and eardrum look like. Don’t be discouraged if you
can’t see the eardrum at first-it takes some practice and experience.

How It Feels

Examining a healthy ear using an otoscope
is usually painless but may cause some mild discomfort if the person being
examined has an ear infection.


The pointed end of the otoscope can irritate the
lining of the ear canal. Make sure that you insert the otoscope slowly and
carefully. If you do scrape the lining of the ear canal, it rarely causes
bleeding or infection, but you must be careful to avoid pain or injury.

An otoscope can push an object closer to the eardrum. If you suspect an
object in the ear, do not move the otoscope forward once you see the object.
Don’t try to remove the object-seek medical help.

There is a
slight risk of damaging the eardrum if the otoscope is inserted too far into
the ear canal. Do not move the otoscope forward if it feels like something is
blocking it.


A home ear examination is a visual
inspection of the
ear canal and eardrum using an instrument called an

Ear canal
  • Ear canals vary in size, shape, and
  • The ear canal is skin-colored and contains small hairs and
    usually some yellowish brown or reddish brown
  • Wiggling or pulling on the outer ear
    causes pain.
  • The ear canal is red, tender, swollen, or filled with
  • The eardrum is pearly white or light
    gray, and you can see through it.
  • You can see the tiny bones of
    the middle ear pushing on the eardrum.
  • You see a cone of light,
    known as the “light reflex,” reflecting off the surface of the eardrum. This
    cone of light is at the 5 o’clock position in the right ear and at the 7
    o’clock position in the left ear.
  • The light reflex on the eardrum is dull
    or absent
  • The eardrum is red and bulging.
  • You can often
    see amber liquid or bubbles behind the eardrum.
  • You can see a hole
    in the eardrum (perforation).
  • You can see whitish scars on the
    surface of the eardrum.
  • If your child has had a tube placed in an
    ear, you may also see the tiny plastic tube, which is usually blue or
  • The eardrum is blocked by earwax or an object, such as a
    bean or a bead.

If you see an inflamed canal, pus, a dull or red eardrum,
fluid behind the eardrum, a hole in the eardrum, or a foreign object in the
ear, call your doctor.

What Affects the Test

Reasons why the results of the
test may not be helpful include:

  • Lying down while the ear is being examined.
    This can make it hard to detect the presence of a middle ear infection
    (otitis media) or fluid behind the eardrum (otitis media with effusion).
  • Crying. A
    small child who is upset or crying may have red eardrums. It is easy to confuse
    this redness with an ear infection.

What To Think About

  • Some home otoscopes use sound waves that bounce
    off the eardrum to detect otitis media with
    effusion (fluid in the middle ear).
  • Earwax (cerumen) is a normal protective secretion of the
    ear canal. Earwax normally drains by itself, and cleaning the outside of the
    ear is all that is necessary. Never clean your ear canals with cotton swabs,
    hairpins, paper clips, or your fingernail, which may damage the canal or
    eardrum and can push the wax farther into the canal. For information on how to
    remove earwax, see the topic

Regardless of what you see with a otoscope, call your
doctor if you or your child has:

  • Severe ear pain, especially if your child has a
  • Sudden hearing loss.
  • Dizziness.
  • An
    inability to move the muscles on one side of the face (facial nerve
  • Persistent ringing in one or both
  • Drainage from one or both ears.


Other Works Consulted

  • Committee on Practice and Ambulatory Medicine, Bright Futures Periodicity Schedule Workgroup (2014). 2014 recommendations for pediatric preventive health care. Pediatrics, published online February 24, 2014. DOI: 10.1542/peds.2013-4096. Accessed March 7, 2014.


ByHealthwise Staff
Primary Medical Reviewer Susan C. Kim, MD – Pediatrics
Specialist Medical Reviewer Charles M. Myer, III, MD – Otolaryngology

Current as ofMay 4, 2017