Otoscopy ResourcesWhat 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.

Left Ear

Right Ear

What conditions do audiologists use otoscopy to diagnose?

● Cerumen (earwax) impaction

● Foreign object(s) in the external auditory canal

● Otitis externa (swimmer’s ear)

● Otitis media with or without effusion

● Preauricular pits or tags

● Abnormal skin lesion/spot

What medical professionals can SLPs refer to if a patient has abnormal findings during an otoscopic

exam?

● Audiologist

● Primary Care Physician/Pediatrician

● Dermatologist

● Otolaryngologist (ENT)

For more information, please refer to the following resources:

American Speech-Language-Hearing Association. (n.d.) Adult hearing screening. ASHA Practice portal,

professional issues. www.asha.org.

American Speech-Language-Hearing Association. (n.d.) Childhood hearing screening. ASHA Practice portal,professional issues. www.asha.org.

American Speech-Language-Hearing Association. (2016). Scope of practice in speech-language pathology. [Scopeof Practice Paper]. www.asha.org/policy.

American Speech-Language-Hearing Association. (2019). Speech-language pathology assistant scope of practice.[Scope of Practice]. www.asha.org/policy.

Dowd, Kathy. (2020). The importance of hearing screening in our youngest and most senior clients. ASHAWIRE,

Leader Live. https://leader.pubs.asha.org/do/10.1044/the-importance-of-hearing-screening/full/