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Otolaryngological examination

External examination reveals deformation of the auricle, swelling, hyperemia in the region of the mastoid process, auricle, enlarged lymph nodes in the tragus, mastoid process, below the auricle, postoperative scars, condition of entry into the external auditory canal, discharge from the ear, and violation of facial expressions during damage to the facial nerve. On palpation, soreness, volume and consistency of tissue in places of inflammation and pathological changes are noted.

Otoscopy is performed using the frontal reflector and the ear funnel. The reflector is aimed at the membrane so that the light beam does not change its position when closing and opening the left eye. Specialists can perform otoscopy using an optical otoscope or microscope.

To examine the right ear, the ear funnel is inserted gently with the right hand into the initial part of the cartilaginous part of the auditory meatus, and the auricle is slightly pulled with the left hand (with otoscopy of the left ear, vice versa) up and back in adults, and in young children, down. In this case, the auditory meatus straightens and the membrane becomes visible.

For better visibility of the membrane to an inexperienced doctor, it is advisable to remove the secretions in the ear canal (sulfur, epidermis, dried pus) using an ear tissue holder or attic probe Voyachek. In the ear canal, the presence of secretions (pus, blood), swelling of its walls in the cartilaginous or bone part, constrictions, etc. are noted.

When otoscopy, attention is paid to the identification points of the eardrum - the handle of the malleus, its short process, light cone, front and rear transitional folds above the short process.
The color of the membrane is noted (pearly gray is normal, and with otitis media, a different degree of hyperemia). The position of the membrane is determined (retracted, swells) and mobility using an optical funnel or an impedance meter. With the presence of perforation, its size, shape, nature of the edges (with otitis media in chronic cases, scarring) and localization by quadrants (anteroposterior, anterior-inferior, posterior-superior and posterior-inferior) are noted. Distinguish rim and marginal perforations. With the first of them, the membrane tissue is preserved near the tympanic ring, and the second reaches the bone.

Characterized by color, smell (rotten cheese with cholesteatoma), consistency, degree of discharge from the middle ear, the condition of the mucous membrane of the tympanic cavity during perforations. In case of marginal perforations, primarily in the shrapnel portion of the membrane, sounding is performed using an attic Voyachek probe to determine bone caries and cholesteatoma. After a thorough toilet of the ear canal and tympanic cavity, one can better evaluate the data of otoscopy. Excretions from the ear are subjected to bacteriological examination in order to determine the pathogen and its sensitivity to antibiotics.
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Otolaryngological examination

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