Pneumatic otoscopy is a quick test that takes just a few minutes to complete. The test is usually painless. However, the patient may experience some discomfort or pain if an ear infection is present. Patients are not required to take any special steps in preparation for the procedure.

The physician will begin by dimming the light in the examination room. Young children will be instructed to lie down with their head turned to one side. Smaller children may sit on a parent’s lap and rest their head on the parent’s chest while the physician checks the other ear. Older children and adults will be asked to sit with their head tilted toward one shoulder, allowing the ear on the opposite side to be examined.

For the pneumatic otoscopy to be a success, the patient must hold very still. Because children make up the majority of patients needing these exams, parents can provide valuable help in keeping the child calm during the procedure. For example, parents may hold their child’s hand and sit on one side of the child while the examiner checks the opposite ear.

The physician will ask the patient to hold very still before peering into the ear through a speculum attached to a handheld, lighted device called a pneumatic otoscope. The physician will hold the device in one hand, while using the other to gently pull the ear up, back or forward. This straightens the ear canal and enables the physician to get a better view of the inside of the ear. The otoscope is then slowly inserted into the ear canal. As the physician examines the ear through the otoscope, he or she is careful not to insert the device too deeply.

If the patient has excessive amounts of earwax (cerumen), the physician will need to remove it before continuing with the pneumatic otoscopy.  

Initially, the physician will do a simple visual exam of the eardrum (tympanic membrane). When there is infection or fluid behind the eardrum, the physician or other healthcare provider may see one or more of the following indicators:

• The eardrum may bulge, or may be sucked in.
  
  
• The eardrum may be opaque or dull in appearance. A healthy eardrum should be translucent and have a shiny appearance. It will be difficult for the physician to see through an unhealthy eardrum.
  
  
• The eardrum may look yellow, gray or red. However, it should be noted that children’s eardrums often turn red when they cry, or when they have a cold or other respiratory infection. So, redness does not necessarily indicate infection.
  
  
• Amber fluid or bubbles behind the eardrum.
  
  
• Other irregularities in the eardrum may appear, including swelling, lesions, discharge, foreign bodies and perforation.

After completing the initial visual inspection, the physician will squeeze a small, rubber bulb attached to the pneumatic otoscope. This sends a puff of air into the ear, increasing pressure. A healthy eardrum will respond to this change by moving easily. If the eardrum does not appear to move or moves sluggishly, the presence of fluid in the middle ear is likely. Scarring or thickening of an inflamed eardrum also can restrict its ability to move.

Pneumatic otoscopy is a safe, painless procedure with no significant risks. The only possible risk for patients is the spread of infection from one ear to another. However, this may only occur if the otoscope is not disinfected before being placed in each ear.