Page 374 - Saunders Comprehensive Review For NCLEX-RN

Before performing an otoscopic exam and inserting the

speculum, check the auditory canal for foreign bodies. Instruct the client
not to move the head during the examination to avoid damage to the
canal and tympanic membrane.
a. The client’s head is tilted slightly away
and the otoscope is held upside down
as if it were a large pen; this permits
the examiner’s hand to lay against the
client’s head for support.
b. In an adult, pull the pinna up and back
to straighten the external canal.
c. Visualize the external canal while
slowly inserting the speculum.
d. The normal external canal is pink and
intact, without lesions and with
varying amounts of cerumen and fine
little hairs.
e. Assess the tympanic membrane for
intactness; the normal tympanic
membrane is intact, without
perforations, and should be free from
lesions.
f. The tympanic membrane is transparent,
opaque, pearly gray, and slightly
concave. The cone of light reflex is
noted at 5 o’clock on the right and 7
o’clock on the left, and there is positive
mobility when the client swallows.
g. A fluid line or the presence of air
bubbles is not normally visible.
h. If the tympanic membrane is bulging or
retracting, the edges of the light reflex
will be fuzzy (diffuse) and may spread
over the tympanic membrane.

The otoscope is never introduced blindly

into the external canal because of the risk of
perforating the tympanic membrane.
9. Refer to Chapter 56 for diagnostic tests related to the
ear.
10. Client teaching
a. Instruct the client to notify the PHCP if
an alteration in hearing or ear pain or
ringing in the ears occurs, or if redness,
swelling, or drainage from the ear is
noted.

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