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The Ear Examination Evolution
With the announcement of 7 new national Pharmacy First services it is time for pharmacists to rapidly upskill and get comfortable with looking in peoples👂and as with everything else it will be a practice makes perfect situation. I have been using otoscopes and looking in ears for about 10 years now so some websites, videos and links below that may be helpful.
How do I do an ear examination?
There is no replacement for good quality Face to Face training from an experienced provider, so please make sure you book on to training that works for you locally. Speak to your LPC, or have a look at Community Pharmacy England resouces. They currently point to a suite of Centre for Postgraduate Pharmacy Education resources including this Video
Cliniskills also offer FREE training and there are various webinars that can be watched later too. Click the logo below to take you to their sign up page.
Other Videos
I am a big fan of Geeky Medics who have the below fantastic “OSCE Standard” video on ear examination and hearing tests.
Its worth having a look at other videos on their YouTube channel too as they have videos that will be useful for other clinical examination skills too.
Finally there is a very comprehensive video from Dr James Gill, that goes into the detailed anatomy
What otoscope should I buy?
NHS England have helpfully provided some guidance on otoscopes in Annexe C of the Service Specification however the cost range of Otoscopes varies hugely from about £10 to £1000! Below are some thoughts from the few I’ve tried.
cheap and cheerful
YNR England F.O Mini Otoscope Auriscope Fiber Optic ENT Medical Diagnostic Examination GP CE Mark Approved (Black)
There are dozens of Sub £20 otoscopes on eBay and Amazon and I carry one of these in myMy “kit bag”. There aren’t any bells and whistles and they miss a few of the “recommendations” on the guidance in the spec, but for not much money, they are worth it for a practice/back up otoscope in my opinion.
not really an otoscope…
Qimix Ear Wax Removal Kit Camera
I bought this one after watching an eGPlearning video on a similar product to look in my kids ears. Although in no way related to the service spec these are also cheap and another useful gadget to have at your disposal. This one links to and Android device via WiFi but you can also get iPhone and PC versions that connect via USB too.
something a little different…
Arclight - Ophthalmoscope-Loupe-Otoscope
Another YouTube find! this cool bit of kit, from Dr Gandalf again
and there is an excellent Geeky Medics page too. The device has been developed by the Arclight Project social enterprise led by the University of St Andrews in Scotland.
Originally made to overcome barriers to ownership in low-resource settings there are now over 28,000 devices worldwide. The scientific evidence base for its effectiveness has grown and it is consequently gaining traction amongst medical students in wealthier countries too.
The Pricier Options (if you can find stock!)
This is one of the “traditional” brands of Otoscope that you will commonly find in GP surgeries up and down the land and can be found for around £100, I would suggest the Fibre Optic version, as this presents a “ring” of light, rather than direct illumination via a bulb. Like other pieces of medical equipment some clinicians will have their preferred brands, which they will swear is “the best” so speak to colleagues for their thoughts. Other common examples include, Keeler, Welch Allyn, Riester, & Heine although stocks are currently limited on many of the major suppliers, probably due to the demand of 10,000 pharmacies needing one!
Final Thoughts
Whichever of the options above you chose, the way you will get competent with using the Otoscope its lots of practice! Practice on friends and family (if they will let you!) and do face to face learning where you can. Good luck!
(The photo at the top of this blog is from NEJM: A Spider and Its Exoskeleton in the Ear Canal … I haven’t seen any insects in ear canals yet, let me know if you do🕷️)
