Roderick P Venekamp general practitioner, assistant professor of primary care, Anne G M Schilder ear, nose, and throat surgeon, professor of paediatric otorhinolaryngologyNIHR senior investigator, Maaike van den Heuvel pharmacist and patient and public involvement representative, Alastair D Hay general practitioner, professor of primary care, and NIHR senior investigator
Venekamp R P, Schilder A G M, van den Heuvel M, Hay A D.
Acute middle ear infection (acute otitis media) in children
BMJ 2020; 371 :m4238
doi:10.1136/bmj.m4238
Re: Acute middle ear infection (acute otitis media) in children
Dear Editor,
This article is very helpful as is the reference to the Wisconsin pictures. The Dutch practised tympanocetis for longer than in the U.K. I suspect that here the majority of diagnoses are made on general symptoms. It is not easy to get a good view of the eardrum of a distressed struggling toddler. The usual method is more likely to obtain a biopsy of the lining of the canal. There are two suggestions.
First, the auriscope should be held with the barrel pointing to the ceiling, NOT the floor. The ulnar aspect of the hand holding it can be pressed firmly against the side of the head. This means the Right hand should be used when inspecting the Right ear (and vice versa). The index finger and thumb of the other hand gently pull the pinna backwards. Both hands are in touch with the child's head and move with the child. The tip of the auriscope can be introduced without causing pain.
Secondly, I await the clinical evaluation of the "scopes" available on the internet advertised for wax clearance. They can be used to obtain a photograph of the eardrum which may help to resolve any uncertainty.
Competing interests: No competing interests