13 otoscope use

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Louise Fincher, EdD, ATC, L Louise Fincher, EdD, ATC, L Associate Professor/Program Direc Associate Professor/Program Direc The University of Texas at Arling The University of Texas at Arling Use of the Use of the Otoscope Otoscope in in Athletic Athletic Training Training

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Page 1: 13 Otoscope Use

Louise Fincher, EdD, ATC, LATLouise Fincher, EdD, ATC, LATAssociate Professor/Program DirectorAssociate Professor/Program Director

The University of Texas at ArlingtonThe University of Texas at Arlington

Use of the Use of the Otoscope in Otoscope in Athletic Athletic TrainingTraining

Page 2: 13 Otoscope Use

Objectives

Briefly discuss the types and features of the Briefly discuss the types and features of the otoscopeotoscope

Provide an overview of otoscopic assessment Provide an overview of otoscopic assessment proceduresprocedures

Present a clinical teaching model for teaching Present a clinical teaching model for teaching your students to properly use the otoscopeyour students to properly use the otoscope

Provide educational resources for teaching Provide educational resources for teaching otoscopyotoscopy

Briefly discuss the types and features of the Briefly discuss the types and features of the otoscopeotoscope

Provide an overview of otoscopic assessment Provide an overview of otoscopic assessment proceduresprocedures

Present a clinical teaching model for teaching Present a clinical teaching model for teaching your students to properly use the otoscopeyour students to properly use the otoscope

Provide educational resources for teaching Provide educational resources for teaching otoscopyotoscopy

Page 3: 13 Otoscope Use

Types & Features of the OtoscopeTypes & Features of the Otoscope

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Types of Otoscopes

Pocket stylePocket style < $50< $50

Pocket stylePocket style < $50< $50

Pocket stylePocket style

Clinical modelClinical model

Clinical modelClinical model $200 - $400+$200 - $400+

Clinical modelClinical model $200 - $400+$200 - $400+

Page 5: 13 Otoscope Use

Features of the Otoscope

Power sourcePower source Battery (most common in Battery (most common in

athletic training clinical athletic training clinical setting)setting)

Electric Electric

Power sourcePower source Battery (most common in Battery (most common in

athletic training clinical athletic training clinical setting)setting)

Electric Electric Light sourceLight source

Incandescent bulb (produces a Incandescent bulb (produces a yellow light)yellow light)

Hallogen bulb (Hallogen bulb (bestbest – – produces a white light)produces a white light)

Light sourceLight source Incandescent bulb (produces a Incandescent bulb (produces a

yellow light)yellow light) Hallogen bulb (Hallogen bulb (bestbest – –

produces a white light)produces a white light)

Page 6: 13 Otoscope Use

Features of the Otoscope

MagnifierMagnifier Not available on all modelsNot available on all models Provides better view of Provides better view of

tympanic membrane, tympanic membrane, particularly for beginners particularly for beginners

MagnifierMagnifier Not available on all modelsNot available on all models Provides better view of Provides better view of

tympanic membrane, tympanic membrane, particularly for beginners particularly for beginners

Page 7: 13 Otoscope Use

Features of the Otoscope

SpeculumSpeculum Variety of sizesVariety of sizes Reusable or disposableReusable or disposable

SpeculumSpeculum Variety of sizesVariety of sizes Reusable or disposableReusable or disposable

Page 8: 13 Otoscope Use

Overview of Otoscopic Overview of Otoscopic AssessmentAssessment

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Examination of the EarExamination of the Ear

HHistoryistoryOObservationbservationPPalpationalpation

HHistoryistoryOObservationbservationPPalpationalpationSSpecialpecial teststests

Otoscopic assessmentOtoscopic assessment

SSpecialpecial teststests Otoscopic assessmentOtoscopic assessment

Page 10: 13 Otoscope Use

Examination of the EarExamination of the Ear

HistoryHistoryHistoryHistory TraumaTrauma Allergies, colds, sinus drainageAllergies, colds, sinus drainage Changes in pressure (flying, diving)Changes in pressure (flying, diving) DizzinessDizziness Changes in hearingChanges in hearing Duration of symptomsDuration of symptoms

TraumaTrauma Allergies, colds, sinus drainageAllergies, colds, sinus drainage Changes in pressure (flying, diving)Changes in pressure (flying, diving) DizzinessDizziness Changes in hearingChanges in hearing Duration of symptomsDuration of symptoms

Page 11: 13 Otoscope Use

Examination of the Ear

ObservationObservationObservationObservation RednessRedness SwellingSwelling DrainageDrainage Foreign objectForeign object Cuts, scrapes, Cuts, scrapes,

bruisesbruises

RednessRedness SwellingSwelling DrainageDrainage Foreign objectForeign object Cuts, scrapes, Cuts, scrapes,

bruisesbruises

Page 12: 13 Otoscope Use

Examination of the Ear

PalpationPalpationPalpationPalpation Gentle pressure Gentle pressure

on traguson tragus

Gentle pressure Gentle pressure on traguson tragus

Page 13: 13 Otoscope Use

Examination of the Ear

PalpationPalpationPalpationPalpation Traction on ear lobe & Traction on ear lobe &

pinnapinna

Traction on ear lobe & Traction on ear lobe & pinnapinna

Page 14: 13 Otoscope Use

Otoscopic Assessment

Evaluate the Evaluate the noninvolved ear firstnoninvolved ear first

Evaluate the Evaluate the noninvolved ear firstnoninvolved ear first

This practice provides This practice provides a basis for comparison a basis for comparison ANDAND prevents cross- prevents cross-contaminationcontamination

This practice provides This practice provides a basis for comparison a basis for comparison ANDAND prevents cross- prevents cross-contaminationcontamination

Page 15: 13 Otoscope Use

Otoscopic Assessment

Step 1:Step 1:Step 1:Step 1: Place your patient in a Place your patient in a

seated position with seated position with his/her head turned his/her head turned slightly downward and slightly downward and away from the ear to be away from the ear to be examinedexamined

Place your patient in a Place your patient in a seated position with seated position with his/her head turned his/her head turned slightly downward and slightly downward and away from the ear to be away from the ear to be examinedexamined

Page 16: 13 Otoscope Use

Otoscopic Assessment

Step 1 (cont.):Step 1 (cont.):Step 1 (cont.):Step 1 (cont.): I teach this as the I teach this as the

“puppy position” “puppy position” (puppies always cock (puppies always cock their heads to the side their heads to the side when you talk to them)when you talk to them)

I teach this as the I teach this as the “puppy position” “puppy position” (puppies always cock (puppies always cock their heads to the side their heads to the side when you talk to them)when you talk to them)

Page 17: 13 Otoscope Use

Otoscopic Assessment

Step 2:Step 2:Step 2:Step 2: Select the largest Select the largest

possible speculum possible speculum that can be that can be comfortably inserted comfortably inserted into the earinto the ear

Select the largest Select the largest possible speculum possible speculum that can be that can be comfortably inserted comfortably inserted into the earinto the ear

Page 18: 13 Otoscope Use

Otoscopic Assessment

Step 2 (cont.):Step 2 (cont.):Step 2 (cont.):Step 2 (cont.): When inserted, the When inserted, the

speculum should fit speculum should fit snugly in the outer snugly in the outer third of the canal third of the canal and rest against the and rest against the tragustragus and anterior and anterior wall of the canalwall of the canal

When inserted, the When inserted, the speculum should fit speculum should fit snugly in the outer snugly in the outer third of the canal third of the canal and rest against the and rest against the tragustragus and anterior and anterior wall of the canalwall of the canal

Modified from Middle Ear Conditions. Anatomical Chart Co. Skokie, IL, 1999.

Page 19: 13 Otoscope Use

Otoscopic Assessment

Step 2 (cont.):Step 2 (cont.):Step 2 (cont.):Step 2 (cont.): Choosing a Choosing a

speculum that is too speculum that is too small will cause small will cause movement within movement within the canal the canal

Excessive Excessive movement can cause movement can cause discomfort for your discomfort for your patientpatient

Choosing a Choosing a speculum that is too speculum that is too small will cause small will cause movement within movement within the canal the canal

Excessive Excessive movement can cause movement can cause discomfort for your discomfort for your patientpatient

Modified from Middle Ear Conditions. Anatomical Chart Co. Skokie, IL, 1999.

Page 20: 13 Otoscope Use

Otoscopic Assessment

Step 3:Step 3:Step 3:Step 3: Hold the otoscope Hold the otoscope

with the same hand as with the same hand as the ear you are the ear you are examining examining right ear, right handright ear, right handleft ear, left handleft ear, left hand

Hold the otoscope Hold the otoscope with the same hand as with the same hand as the ear you are the ear you are examining examining right ear, right handright ear, right handleft ear, left handleft ear, left hand

Page 21: 13 Otoscope Use

Otoscopic Assessment

Step 3 (cont.):Step 3 (cont.):Step 3 (cont.):Step 3 (cont.): The otoscope should The otoscope should

be stabilized by be stabilized by placing the ring and placing the ring and little finger resting on little finger resting on the patient’s cheek or the patient’s cheek or templetemple

The otoscope should The otoscope should be stabilized by be stabilized by placing the ring and placing the ring and little finger resting on little finger resting on the patient’s cheek or the patient’s cheek or templetemple

Page 22: 13 Otoscope Use

Otoscopic Assessment

Pencil GripPencil Grip Hammer GripHammer Grip

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Otoscopic Assessment

Step 4:Step 4:Step 4:Step 4: Pull the pinna Pull the pinna

upward and upward and backward to backward to straighten the straighten the canalcanal

Pull the pinna Pull the pinna upward and upward and backward to backward to straighten the straighten the canalcanal

Modified from Middle Ear Conditions. Anatomical Chart Co. Skokie, IL, 1999.

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Otoscopic Assessment

Step 5:Step 5:Step 5:Step 5: While maintaining While maintaining

traction on the pinna, traction on the pinna, place the speculum place the speculum of the otoscope of the otoscope at, at, but not inbut not in the ear the ear canalcanal

While maintaining While maintaining traction on the pinna, traction on the pinna, place the speculum place the speculum of the otoscope of the otoscope at, at, but not inbut not in the ear the ear canalcanal

Page 25: 13 Otoscope Use

Otoscopic Assessment

Caution:Caution:Caution:Caution: Never insert Never insert

the otoscope the otoscope blindlyblindly

AlwaysAlways“Watch your“Watch your way in” way in”

Never insert Never insert the otoscope the otoscope blindlyblindly

AlwaysAlways“Watch your“Watch your way in” way in”

Page 26: 13 Otoscope Use

Otoscopic Assessment

Tip:Tip:Tip:Tip: If the patient If the patient

experiences pain, experiences pain, reposition the reposition the canal by canal by adjusting the adjusting the angle and degree angle and degree of traction on the of traction on the pinnapinna

If the patient If the patient experiences pain, experiences pain, reposition the reposition the canal by canal by adjusting the adjusting the angle and degree angle and degree of traction on the of traction on the pinnapinna

Page 27: 13 Otoscope Use

Otoscopic Assessment

Caution:Caution:Caution:Caution: If the patient’s If the patient’s

discomfort persists discomfort persists even after even after readjustment of the readjustment of the canal, halt the canal, halt the examination and examination and refer the patient to a refer the patient to a physician.physician.

If the patient’s If the patient’s discomfort persists discomfort persists even after even after readjustment of the readjustment of the canal, halt the canal, halt the examination and examination and refer the patient to a refer the patient to a physician.physician.

Page 28: 13 Otoscope Use

Otoscopic Assessment

Step 6:Step 6:Step 6:Step 6: Once the tympanic Once the tympanic

membrane comes into membrane comes into view, rotate the view, rotate the speculum to view as speculum to view as much of the membrane much of the membrane as possibleas possible

Once the tympanic Once the tympanic membrane comes into membrane comes into view, rotate the view, rotate the speculum to view as speculum to view as much of the membrane much of the membrane as possibleas possible

Posterior superiorPosterior superior Anterior superiorAnterior superior Anterior inferiorAnterior inferior Posterior inferiorPosterior inferior

Posterior superiorPosterior superior Anterior superiorAnterior superior Anterior inferiorAnterior inferior Posterior inferiorPosterior inferior

Marty DR. The Ear Book. Jefferson City, MO: Lang ENT Publishing. 1987;Color plate 1.

Page 29: 13 Otoscope Use

Otoscopic Assessment

Like trying to Like trying to view the corners view the corners of a room through of a room through a key holea key hole

Like trying to Like trying to view the corners view the corners of a room through of a room through a key holea key hole

TipTipTipTip

Marty DR. The Ear Book. Jefferson City, MO: Lang ENT Publishing. 1987;Color plate 1.

Modified from Middle Ear Conditions. Anatomical Chart Co. Skokie, IL, 1999.

Page 30: 13 Otoscope Use

This is due to the angle of the This is due to the angle of the membrane within the canalmembrane within the canal

Otoscopic Assessment

TipTipTipTip The posterior The posterior

inferior portion of inferior portion of the membrane is the membrane is often difficult to often difficult to seesee

The posterior The posterior inferior portion of inferior portion of the membrane is the membrane is often difficult to often difficult to seesee

Fincher AL. Use of the otoscope in the evaluation of common injuries and illnesses of the ear. J Athl Train. 1994;29:53,54.

Modified from Middle Ear Conditions. Anatomical Chart Co. Skokie, IL, 1999.

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Otoscopic Assessment

Step 7:Step 7: Step 7:Step 7:

LR

Inspect the membrane for Inspect the membrane for color, clarity, & position color, clarity, & position Pearly grayPearly graySemitransparentSemitransparentNot bulging or retractedNot bulging or retracted

Inspect the membrane for Inspect the membrane for color, clarity, & position color, clarity, & position Pearly grayPearly graySemitransparentSemitransparentNot bulging or retractedNot bulging or retracted

Fincher AL. Use of the otoscope in the evaluation of common injuries and illnesses of the ear. J Athl Train. 1994;29:53,54.

Page 32: 13 Otoscope Use

Otoscopic Assessment

Step 8:Step 8: Identify key landmarksIdentify key landmarks

Step 8:Step 8: Identify key landmarksIdentify key landmarks

LR

UmboUmbo

Short Short processprocessMalleusMalleusMalleusMalleus

• ManubriumManubrium• Short process Short process • UmboUmbo

• ManubriumManubrium• Short process Short process • UmboUmbo

Light reflexLight reflexLight reflexLight reflex

Fincher AL. Use of the otoscope in the evaluation of common injuries and illnesses of the ear. J Athl Train. 1994;29:53,54.

Page 33: 13 Otoscope Use

Otoscopic Assessment

Step 8 (cont.):Step 8 (cont.): Identify key landmarksIdentify key landmarks

Step 8 (cont.):Step 8 (cont.): Identify key landmarksIdentify key landmarks

LR

Note that manubrium Note that manubrium angles toward the 10:00 angles toward the 10:00 position in the left ear position in the left ear and the 2:00 position in and the 2:00 position in the right earthe right ear

Note that manubrium Note that manubrium angles toward the 10:00 angles toward the 10:00 position in the left ear position in the left ear and the 2:00 position in and the 2:00 position in the right earthe right ear

Fincher AL. Use of the otoscope in the evaluation of common injuries and illnesses of the ear. J Athl Train. 1994;29:53,54.

Page 34: 13 Otoscope Use

Otoscopic Assessment

Step 8 (cont.):Step 8 (cont.): Identify key landmarksIdentify key landmarks

Step 8 (cont.):Step 8 (cont.): Identify key landmarksIdentify key landmarks

LR

Pars tensaPars tensa

Pars flaccidaPars flaccidaPars flaccidaPars flaccidaPars tensaPars tensaPars tensaPars tensaAnnulusAnnulusAnnulusAnnulus

Pars flaccidaPars flaccida

Fincher AL. Use of the otoscope in the evaluation of common injuries and illnesses of the ear. J Athl Train. 1994;29:53,54.

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Otoscopic Assessment

Step 8 (cont.):Step 8 (cont.): Step 8 (cont.):Step 8 (cont.): Identify key landmarksIdentify key landmarks

Look beyond the membraneLook beyond the membrane

• StapesStapes

• IncusIncus

Identify key landmarksIdentify key landmarksLook beyond the membraneLook beyond the membrane

• StapesStapes

• IncusIncus

Fincher AL. Use of the otoscope in the evaluation of common injuries and illnesses of the ear. J Athl Train. 1994;29:53.

Page 36: 13 Otoscope Use

Otoscopic Assessment

Step 9:Step 9: Look for abnormalitiesLook for abnormalities

FluidFluidPerforationsPerforations

Step 9:Step 9: Look for abnormalitiesLook for abnormalities

FluidFluidPerforationsPerforations

PerforationMarty DR. The Ear Book. Jefferson City, MO: Lang ENT Publishing. 1987;Color plate 8.

Fluid & Air BubblesFincher AL. Use of the otoscope in the evaluation of common injuries andillnesses of the ear. J Athl Train. 1994;29:54.

Page 37: 13 Otoscope Use

Otoscopic Assessment

Step 10Step 10Step 10Step 10 Work with your team physician to Work with your team physician to

develop your confidence and skilldevelop your confidence and skill

Work with your team physician to Work with your team physician to develop your confidence and skilldevelop your confidence and skill

PRACTICE, PRACTICE, PRACTICE !!!PRACTICE, PRACTICE, PRACTICE !!! You must look at many ears to develop to You must look at many ears to develop to

become comfortable with “normal”become comfortable with “normal”

PRACTICE, PRACTICE, PRACTICE !!!PRACTICE, PRACTICE, PRACTICE !!! You must look at many ears to develop to You must look at many ears to develop to

become comfortable with “normal”become comfortable with “normal”

Page 38: 13 Otoscope Use

Instructional Overview

Page 39: 13 Otoscope Use

Instructional Overview

Ear exam, ear pathology, and use of Ear exam, ear pathology, and use of otoscope discussed in classroom settingotoscope discussed in classroom setting

Ear exam, ear pathology, and use of Ear exam, ear pathology, and use of otoscope discussed in classroom settingotoscope discussed in classroom setting

Skills taught and Skills taught and practicedpracticed in lab setting in lab setting Proficiency developed in clinical settingProficiency developed in clinical setting GoalsGoals

Optimize hands-on learning timeOptimize hands-on learning time Provide formative feedback throughout formal and Provide formative feedback throughout formal and

informal practice timeinformal practice time Encourage and develop confidence, critical-Encourage and develop confidence, critical-

thinking, and problem-solvingthinking, and problem-solving

Skills taught and Skills taught and practicedpracticed in lab setting in lab setting Proficiency developed in clinical settingProficiency developed in clinical setting GoalsGoals

Optimize hands-on learning timeOptimize hands-on learning time Provide formative feedback throughout formal and Provide formative feedback throughout formal and

informal practice timeinformal practice time Encourage and develop confidence, critical-Encourage and develop confidence, critical-

thinking, and problem-solvingthinking, and problem-solving

Page 40: 13 Otoscope Use

Clinical Teaching Model

Guided, self-directed activities (pre-lab)Guided, self-directed activities (pre-lab)Guided, self-directed activities (pre-lab)Guided, self-directed activities (pre-lab)

Instructional LabInstructional LabInstructional LabInstructional Lab

Guided, self-directed activities (post-lab)Guided, self-directed activities (post-lab)Guided, self-directed activities (post-lab)Guided, self-directed activities (post-lab)

Guided practice with peers under Guided practice with peers under supervision of ACI (learning lab)supervision of ACI (learning lab)

Guided practice with peers under Guided practice with peers under supervision of ACI (learning lab)supervision of ACI (learning lab)

Guided, clinical practiceGuided, clinical practiceGuided, clinical practiceGuided, clinical practice

Implementation into clinical practice; Implementation into clinical practice; clinical decision-makingclinical decision-making

Implementation into clinical practice; Implementation into clinical practice; clinical decision-makingclinical decision-making

Page 41: 13 Otoscope Use

Guided, Self-Directed Activities

Initially completed Initially completed PRIORPRIOR to lab, but to lab, but may be repeated throughout learning may be repeated throughout learning process as neededprocess as needed

Initially completed Initially completed PRIORPRIOR to lab, but to lab, but may be repeated throughout learning may be repeated throughout learning process as neededprocess as needed MultimediaMultimedia Web-based programsWeb-based programs Article/chapter readingArticle/chapter reading WorksheetsWorksheets Peer learningPeer learning

MultimediaMultimedia Web-based programsWeb-based programs Article/chapter readingArticle/chapter reading WorksheetsWorksheets Peer learningPeer learning

Page 42: 13 Otoscope Use

Guided, Self-Directed Activities

ContentContentContentContent Essential anatomyEssential anatomy Features of the otoscopeFeatures of the otoscope Steps for using the otoscopeSteps for using the otoscope Test for understandingTest for understanding Open ended questions to begin Open ended questions to begin

development of problem-solving and development of problem-solving and critical-thinkingcritical-thinking

Essential anatomyEssential anatomy Features of the otoscopeFeatures of the otoscope Steps for using the otoscopeSteps for using the otoscope Test for understandingTest for understanding Open ended questions to begin Open ended questions to begin

development of problem-solving and development of problem-solving and critical-thinkingcritical-thinking

Page 43: 13 Otoscope Use

Guided, Self-Directed Activities

Advantages Advantages Advantages Advantages Provide students with essential Provide students with essential

knowledge knowledge Requires student to assume responsibility Requires student to assume responsibility

for their own learningfor their own learning Optimizes hands-on time in labOptimizes hands-on time in lab Promote problem solving & critical Promote problem solving & critical

thinkingthinking

Provide students with essential Provide students with essential knowledge knowledge

Requires student to assume responsibility Requires student to assume responsibility for their own learningfor their own learning

Optimizes hands-on time in labOptimizes hands-on time in lab Promote problem solving & critical Promote problem solving & critical

thinkingthinking

Page 44: 13 Otoscope Use

Instructional Lab

Structured Structured Structured Structured Begin with questions to check Begin with questions to check

understanding of self-directed activitiesunderstanding of self-directed activities Brief overview of otoscopic exam Brief overview of otoscopic exam

(2 (2ndnd exposure of material) exposure of material) Organized lab activity emphasizing step-Organized lab activity emphasizing step-

by-step proceduresby-step procedures Formative evaluation with feedbackFormative evaluation with feedback

Begin with questions to check Begin with questions to check understanding of self-directed activitiesunderstanding of self-directed activities

Brief overview of otoscopic exam Brief overview of otoscopic exam (2 (2ndnd exposure of material) exposure of material)

Organized lab activity emphasizing step-Organized lab activity emphasizing step-by-step proceduresby-step procedures

Formative evaluation with feedbackFormative evaluation with feedback

Page 45: 13 Otoscope Use

Guided Practice with Peers

Supervision of ACISupervision of ACISupervision of ACISupervision of ACI Students are tentative and awkward in Students are tentative and awkward in

this stage of learningthis stage of learning They typically leave out steps – They typically leave out steps –

checklists are helpful for remediation of checklists are helpful for remediation of necessary stepsnecessary steps

Not comfortable with practicing skill in Not comfortable with practicing skill in public (on their athletes/patients within public (on their athletes/patients within the clinical setting)the clinical setting)

Students are tentative and awkward in Students are tentative and awkward in this stage of learningthis stage of learning

They typically leave out steps – They typically leave out steps – checklists are helpful for remediation of checklists are helpful for remediation of necessary stepsnecessary steps

Not comfortable with practicing skill in Not comfortable with practicing skill in public (on their athletes/patients within public (on their athletes/patients within the clinical setting)the clinical setting)

Page 46: 13 Otoscope Use

Guided Practice with Peers

Structured practiceStructured practiceStructured practiceStructured practice Complete 20 correct evaluations Complete 20 correct evaluations

(10L, 10R) – documented by ACI and/or peer(10L, 10R) – documented by ACI and/or peer WorksheetsWorksheets

Drawing what they seeDrawing what they seeRecording what they seeRecording what they see

• Presence of wax?Presence of wax?• Were they able to see the membrane?Were they able to see the membrane?• What did the membrane look like?What did the membrane look like?

Complete 20 correct evaluations Complete 20 correct evaluations (10L, 10R) – documented by ACI and/or peer(10L, 10R) – documented by ACI and/or peer

WorksheetsWorksheetsDrawing what they seeDrawing what they seeRecording what they seeRecording what they see

• Presence of wax?Presence of wax?• Were they able to see the membrane?Were they able to see the membrane?• What did the membrane look like?What did the membrane look like?

Page 47: 13 Otoscope Use

Guided, Self-Directed Activities – Post LabTypes of activitiesTypes of activitiesTypes of activitiesTypes of activities

WorksheetsWorksheets MultimediaMultimedia Case-studiesCase-studies Problem solving scenariosProblem solving scenarios Literature reviewsLiterature reviews

WorksheetsWorksheets MultimediaMultimedia Case-studiesCase-studies Problem solving scenariosProblem solving scenarios Literature reviewsLiterature reviews

Page 48: 13 Otoscope Use

Guided, Self-Directed Activities – Post LabContentContentContentContent

Recognition of pathologyRecognition of pathology Red, tender canalRed, tender canal inflammationinflammation otitis externa otitis externa Bright red membraneBright red membrane inflammationinflammation otitis media otitis media Yellowish membraneYellowish membrane pus/fluid pus/fluid otitis media otitis media Bluish membraneBluish membrane bloodblood skull fx skull fx Bubbles behind membraneBubbles behind membrane fluidfluid otitis media otitis media Absent light reflexAbsent light reflex bulging of TMbulging of TM otitis media otitis media Oval dark areasOval dark areas perforationperforation rupture of rupture of

TMTM Malleus very prominentMalleus very prominent retraction of TM obstruction retraction of TM obstruction

ETET

Recognition of pathologyRecognition of pathology Red, tender canalRed, tender canal inflammationinflammation otitis externa otitis externa Bright red membraneBright red membrane inflammationinflammation otitis media otitis media Yellowish membraneYellowish membrane pus/fluid pus/fluid otitis media otitis media Bluish membraneBluish membrane bloodblood skull fx skull fx Bubbles behind membraneBubbles behind membrane fluidfluid otitis media otitis media Absent light reflexAbsent light reflex bulging of TMbulging of TM otitis media otitis media Oval dark areasOval dark areas perforationperforation rupture of rupture of

TMTM Malleus very prominentMalleus very prominent retraction of TM obstruction retraction of TM obstruction

ETET

Page 49: 13 Otoscope Use

Guided, Self-Directed Activities – Post LabContentContent

Recognition of pathology – visual imagesRecognition of pathology – visual images

ContentContent Recognition of pathology – visual imagesRecognition of pathology – visual images

PerforationMarty DR. The Ear Book. Jefferson City, MO: Lang ENT Publishing. 1987;Color plate 8.

Middle ear fluidMarty DR. The Ear Book. Jefferson City, MO: Lang ENT Publishing. 1987;Color plate 3.

Page 50: 13 Otoscope Use

Guided, Self-Directed Activities – Post LabContentContent

Recognition of pathology – visual imagesRecognition of pathology – visual images

ContentContent Recognition of pathology – visual imagesRecognition of pathology – visual images

PerforationModified from Middle Ear Conditions. Anatomical Chart Co., Skokie, IL. 1999.

Otitis MediaModified from Middle Ear Conditions. Anatomical Chart Co., Skokie, IL. 1999.

Page 51: 13 Otoscope Use

Guided Clinical Practice

Under supervision of ACIUnder supervision of ACIUnder supervision of ACIUnder supervision of ACI Students begin to develop confidence in Students begin to develop confidence in

the procedures of an otoscopic examthe procedures of an otoscopic exam Students gain confidence in identifying Students gain confidence in identifying

landmarks of membranelandmarks of membrane

Students begin to develop confidence in Students begin to develop confidence in the procedures of an otoscopic examthe procedures of an otoscopic exam

Students gain confidence in identifying Students gain confidence in identifying landmarks of membranelandmarks of membrane

Page 52: 13 Otoscope Use

Implementation into Clinical Practice Occurs during following semesterOccurs during following semester

Any clinical rotationAny clinical rotationColds, flus, allergies occur throughout all Colds, flus, allergies occur throughout all

sports (i.e., upper and lower extremity sports, sports (i.e., upper and lower extremity sports, equipment intensive sports, etc.)equipment intensive sports, etc.)

General medical rotationGeneral medical rotation Proficiency developed & evaluated through Proficiency developed & evaluated through

“real-life” cases or scenario-based “real-life” cases or scenario-based presentationspresentations

Occurs during following semesterOccurs during following semester Any clinical rotationAny clinical rotation

Colds, flus, allergies occur throughout all Colds, flus, allergies occur throughout all sports (i.e., upper and lower extremity sports, sports (i.e., upper and lower extremity sports, equipment intensive sports, etc.)equipment intensive sports, etc.)

General medical rotationGeneral medical rotation Proficiency developed & evaluated through Proficiency developed & evaluated through

“real-life” cases or scenario-based “real-life” cases or scenario-based presentationspresentations

Page 53: 13 Otoscope Use

Educational Resources

Page 54: 13 Otoscope Use

Educational Resources

ArticlesArticlesArticlesArticles Lenker C. Lenker C. Traumatic tympanic Traumatic tympanic

membrane perforation in a collegiate membrane perforation in a collegiate football player.football player. Athletic Therapy Today.Athletic Therapy Today. 2000;5(1):43-44.2000;5(1):43-44.

Fincher AL. Fincher AL. Use of the otoscope in the Use of the otoscope in the evaluation of common injuries and evaluation of common injuries and illnesses of the ear.illnesses of the ear. J Athl Train.J Athl Train. 1994;29:52-59.1994;29:52-59.

Lenker C. Lenker C. Traumatic tympanic Traumatic tympanic membrane perforation in a collegiate membrane perforation in a collegiate football player.football player. Athletic Therapy Today.Athletic Therapy Today. 2000;5(1):43-44.2000;5(1):43-44.

Fincher AL. Fincher AL. Use of the otoscope in the Use of the otoscope in the evaluation of common injuries and evaluation of common injuries and illnesses of the ear.illnesses of the ear. J Athl Train.J Athl Train. 1994;29:52-59.1994;29:52-59.

Page 55: 13 Otoscope Use

Educational Resources

ArticlesArticlesArticlesArticles Sloand-Miola E. Sloand-Miola E. The otoscope: an update The otoscope: an update

on assessment skills.on assessment skills. J Ped Nurs.J Ped Nurs. 1994; 1994; 9: 283-286.9: 283-286.

Kaleida PH. Kaleida PH. The COMPLETES exam for The COMPLETES exam for otitis.otitis. Contemporary Pediatrics.Contemporary Pediatrics. 1997;14(9): 93-101.1997;14(9): 93-101.

Sloand-Miola E. Sloand-Miola E. The otoscope: an update The otoscope: an update on assessment skills.on assessment skills. J Ped Nurs.J Ped Nurs. 1994; 1994; 9: 283-286.9: 283-286.

Kaleida PH. Kaleida PH. The COMPLETES exam for The COMPLETES exam for otitis.otitis. Contemporary Pediatrics.Contemporary Pediatrics. 1997;14(9): 93-101.1997;14(9): 93-101.

Page 56: 13 Otoscope Use

Educational Resources

BooksBooksBooksBooks Hawke M, Keene M, Alberti PW. Hawke M, Keene M, Alberti PW.

Clinical Otoscopy: An Introduction to Clinical Otoscopy: An Introduction to Ear Diseases.Ear Diseases. 2 2ndnd ed. New York, NY: ed. New York, NY: Churchill Livingstone; 1990.Churchill Livingstone; 1990.

Swartz MH. Swartz MH. Textbook of Physical Textbook of Physical Diagnosis: History and Examination.Diagnosis: History and Examination. W.B. Saunders; 2002:273-276.W.B. Saunders; 2002:273-276.

Hawke M, Keene M, Alberti PW. Hawke M, Keene M, Alberti PW. Clinical Otoscopy: An Introduction to Clinical Otoscopy: An Introduction to Ear Diseases.Ear Diseases. 2 2ndnd ed. New York, NY: ed. New York, NY: Churchill Livingstone; 1990.Churchill Livingstone; 1990.

Swartz MH. Swartz MH. Textbook of Physical Textbook of Physical Diagnosis: History and Examination.Diagnosis: History and Examination. W.B. Saunders; 2002:273-276.W.B. Saunders; 2002:273-276.

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Educational Resources

Team physicianTeam physicianNursing or other allied health Nursing or other allied health

departments on your campusdepartments on your campus

Team physicianTeam physicianNursing or other allied health Nursing or other allied health

departments on your campusdepartments on your campus

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Summary

Although otoscopy is a new skill for athletic Although otoscopy is a new skill for athletic trainers, it is one that can be easily mastered trainers, it is one that can be easily mastered with proper instruction and guided practice.with proper instruction and guided practice.

ACIs and CIs must also be proficient with ACIs and CIs must also be proficient with using the otoscope if they are to direct and using the otoscope if they are to direct and supervise the students’ clinical education supervise the students’ clinical education experiences involving ear evaluationexperiences involving ear evaluation

Although otoscopy is a new skill for athletic Although otoscopy is a new skill for athletic trainers, it is one that can be easily mastered trainers, it is one that can be easily mastered with proper instruction and guided practice.with proper instruction and guided practice.

ACIs and CIs must also be proficient with ACIs and CIs must also be proficient with using the otoscope if they are to direct and using the otoscope if they are to direct and supervise the students’ clinical education supervise the students’ clinical education experiences involving ear evaluationexperiences involving ear evaluation

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Summary

The 10 step process for otoscopy The 10 step process for otoscopy outlined in this presentation is intended outlined in this presentation is intended to serve as foundation for learning and to serve as foundation for learning and becoming comfortable with using the becoming comfortable with using the otoscope for ear evaluation.otoscope for ear evaluation.

The 10 step process for otoscopy The 10 step process for otoscopy outlined in this presentation is intended outlined in this presentation is intended to serve as foundation for learning and to serve as foundation for learning and becoming comfortable with using the becoming comfortable with using the otoscope for ear evaluation.otoscope for ear evaluation.

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Summary

Proficiency requires Proficiency requires PRACTICEPRACTICE, , PRACTICEPRACTICE, & more , & more PRACTICEPRACTICE!!

Proficiency requires Proficiency requires PRACTICEPRACTICE, , PRACTICEPRACTICE, & more , & more PRACTICEPRACTICE!!

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What Questions Do You Have?What Questions Do You Have?

Feel free to contact me with further questions:Feel free to contact me with further questions:[email protected]@uta.edu