Otoscopy Resources What is otoscopy? Otoscopy is a clinical procedure to visualize, examine, and possibly diagnose the head, neck, face, mastoid bone area, external auditory canal, tympanic membrane, and/or middle ear. Providers use an otoscope, a tool that shines a light to illuminate and provide magnification of the ear canal with a disposable (single patient use) speculum, to complete otoscopy. Is it within the scope of practice for speech-language pathologists (SLPs) or speech-language pathology assistants (SLPAs) to conduct otoscopy? Otoscopy is often completed by speech-language pathology practitioners as part of a hearing screening. If an SLPA conducts the screening, they should report results to their supervising speech-language pathologist but should not interpret their findings or refer to other professionals for further evaluation. If an SLP conducts the screening, they may document their observations and refer to the appropriate medical professional for assessment and/or diagnosis. All practitioners should be properly trained prior to completing otoscopy. For more information, please refer to the Speech-Language Pathology and Speech-Language Pathology Assistant Scope of Practice documents provided by the American Speech-Language Hearing Association. How do you conduct an otoscopic examination? Using an otoscope, the provider examines the neck, mastoid, outer, and middle ear. The provider typically holds the otoscope in their dominant hand. The nondominant hand pulls the pinna superior (upward) and posterior (back) to straighten the ear canal. The provider then places the otoscope speculum into the external auditory canal, illuminating the canal and tympanic membrane (eardrum) for visualization. The provider’s dominant hand braces with the pinky and ring finger resting on the patient’s cheek or mastoid bone, which helps to prevent any damage due to sudden movements of the patient’s head and/or body or the clinician’s hand, arm, and/or body. What does the otoscopic examination visualize? During an otoscopic examination, a clinician can view the external auditory canal and tympanic membrane. They can also visualize a cone of light and the malleus bone in individuals with healthy tympanic membranes during otoscopy. When visualizing the eardrum, the malleus bone always points toward the face. For reference purposes, picture the tympanic membrane divided into four quadrants based on the malleus bone: anterior superior, anterior inferior, posterior superior, and posterior inferior. Please review the images that follow, noting the malleus bone and four quadrants. Also note that the cone of light falls in the anterior inferior quadrant.