otoscopy

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/10/02 21:45:11」(JST)

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Otoscope - Image of an otoscope (center)

Anatomy of the human ear.

Right tympanic membrane as seen through a speculum.

An otoscope or auriscope is a medical device which is used to look into the ears. Health care providers use otoscopes to screen for illness during regular check-ups and also to investigate ear symptoms. An otoscope potentially gives a view of the ear canal and tympanic membrane, or eardrum. Since the eardrum is the border separating the external ear canal from the middle ear, its characteristics can be indicative of various diseases of the middle ear space. The presence of cerumen (ear wax), shed skin, pus, canal skin edema, foreign body, and various ear diseases can obscure any view of the eardrum and thus severely compromise the value of otoscopy done with a common otoscope.

The most commonly used otoscopes consist of a handle and a head. The head contains a light source and a simple low-power magnifying lens, typically around 8 diopters. The distal (front) end of the otoscope has an attachment for disposable plastic ear specula. The examiner first straightens the ear canal by pulling on the pinna and then inserts the ear speculum side of the otoscope into the external ear. It is important to brace the hand holding the otoscope against the patient's head to avoid injury to the ear canal by placing the index finger or little finger against the head. The examiner can then look through a lens on the rear of the instrument and see inside the ear canal. In many models, the lens can be removed, which allows the examiner to insert instruments through the otoscope into the ear canal, such as for removing earwax (cerumen). Most models also have an insertion point for a bulb capable of pushing air through the speculum which is called pneumatic otoscope. This puff of air allows an examiner to test the mobility of the tympanic membrane.

Many otoscopes used in doctors offices are wall-mounted, while others are portable. Wall-mounted otoscopes are attached by a flexible power cord to a base, which serves to hold the otoscope when it's not in use and also serves as a source of electric power, being plugged into an electric outlet. Portable models are powered by batteries in the handle; these batteries are usually rechargeable and can be recharged from a base unit. Otoscopes are often sold with ophthalmoscopes as a diagnostic set.

Diseases which may be diagnosed by an otoscope include otitis media and otitis externa, infection of the middle and outer parts of the ear, respectively.

Otoscopes are also frequently used for examining patients' noses (avoiding the need for a separate nasal speculum) and (with the speculum removed) upper throats.

The most commonly used otoscopes--those used in emergency rooms, pediatric offices, general practice, and by internists- are monocular devices. They provide only a two dimensional view of the ear canal, its contents, and usually at least a portion of the eardrum, depending on what is within the ear canal and its status. Another method of performing otoscopy (visualization of the ear) is use of a binocular microscope, in conjunction with a larger metal ear speculum, with the patient supine and the head tilted, which provides a much larger field of view and the added advantages of a stable head, far superior lighting, and most importantly, depth perception. A binocular (two-eyed) view is required in order to judge depth. If wax or other material obstructs the canal and/or a view of the entire eardrum, it can easily and confidently be removed with specialized suction tips and other microscopic ear instruments, whereas the absence of depth perception with the one-eyed view of a common otoscope makes removal of anything more laborious and hazardous. Another major advantage of the binocular microscope is that both of the examiner's hands are free, since the microscope is suspended from a stand. The microscope has up to 40x power magnification, which allows much more detailed viewing of the entire ear canal, and of the entire eardrum, unless edema of the canal skin prevents it. Subtle changes in the anatomy are much more easily detected and interpreted than with a monocular view otoscope. Traditionally only ENT specialists (otolaryngologists) and otologists (subspecialty ear doctors) acquire binocular microscopes and the necessary skills and training to use them, and incorporate their routine use in evaluating patient's ear complaints. Studies have shown that reliance on a monocular otoscope to diagnose ear disease results in a more than 50% chance of misdiagnosis, as compared to binocular microscopic otoscopy. The expense of acquiring a binocular microscope is only one obstacle to its being more widely adapted to general medicine. The low level of familiarity with binocular otoscopy among pediatric and general medicine professors in physician training programs is probably a more difficult obstacle to overcome. Thus the standard of general otologic diagnosis and ear care remains for the most part the largely antiquated monocular otoscope.

External links

An article detailing the use of otoscopes from one of the first issues of the Student BMJ available online published in July 1995.
This archived version of a similar page from wisc.edu contains images.
This archived page from indstate.edu gives another overview with images.
Phisick Pictures and information about antique otoscopes

UpToDate Contents

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2. 小児における身体的診察：HEENT the pediatric physical examination heent
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English Journal

Cervical Spine Dysfunctions in Patients with Chronic Subjective Tinnitus.

Michiels S1, De Hertogh W, Truijen S, Van de Heyning P.
Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.Otol Neurotol.2014 Nov 20. [Epub ahead of print]
OBJECTIVE: To assess, characterize, and quantify cervical spine dysfunction in patients with cervicogenic somatic tinnitus (CST) compared to patients suffering from other forms of chronic subjective non-pulsatile tinnitus.STUDY DESIGN: Cross-sectional study.SETTING: Tertiary referral center.PATIENTS
PMID 25415466

Analysis of subtle auditory dysfunctions in young normal-hearing subjects affected by Williams syndrome.

Paglialonga A1, Barozzi S2, Brambilla D3, Soi D2, Cesarani A2, Spreafico E3, Tognola G4.
International journal of pediatric otorhinolaryngology.Int J Pediatr Otorhinolaryngol.2014 Nov;78(11):1861-5. doi: 10.1016/j.ijporl.2014.08.010. Epub 2014 Aug 17.
OBJECTIVE: To assess if young subjects affected by Williams syndrome (WS) with normal middle ear functionality and normal hearing thresholds might have subtle auditory dysfunctions that could be detected by using clinically available measurements.METHODS: Otoscopy, acoustic reflexes, tympanometry, p
PMID 25193583

Otoscopy simulation training in a classroom setting: A novel approach to teaching otoscopy to medical students.

Davies J1, Djelic L, Campisi P, Forte V, Chiodo A.
The Laryngoscope.Laryngoscope.2014 Nov;124(11):2594-7. doi: 10.1002/lary.24682. Epub 2014 Aug 28.
OBJECTIVES/HYPOTHESIS: To determine the effectiveness of using of an otoscopy stimulator to teach medical students the primary principles of otoscopy in large group training sessions and improve their confidence in making otologic diagnoses.STUDY DESIGN: Cross-sectional survey design.METHODS: In Mar
PMID 24648271

Japanese Journal

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NAID 130004992700

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NAID 130004725649

ダニによる耳鳴り:—イヌミミヒゼンダニの迷入が疑われた症例とムギコナダニによる症例—

加藤俊徳,伊藤八次,中尾弘志,角坂照貴
衛生動物 62(3), 199-204, 2011
… Since mites removed from pets are small, most otolaryngologists overlook or fail to find these mites on standard otoscopy. …
NAID 130004558996

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