Hearing Screening Online Training Program

External and Internal Visual Inspection of the Ears as a Part of the Physical Exam

Qualified Personnel: Physician, Nurse Practitioner, and Physician Assistant. Also licensed school nurse, certified public health nurse, and registered nurse with appropriate training, e.g., training currently provided by the Minnesota Department of Health.

Ages: Birth through 20 years.

Purpose: To check for signs of ear disease and/or abnormal development.

Description: A systematic inspection of the external ear canal, surrounding tissue, and outer third of ear canal.

Equipment: Otoscope for internal inspection.

Facilities: A well-lighted area.

Image showing a 10 degree earslant on a child for screening purposes.
A child’s ear position is normally set at a 10° tilt. Deviation from this position can be a clinical marker of syndromes associated with hearing loss.

Reprinted from Whaley LF, Wong DL, Nursing care of infants and children, 4th ed., Copyright 1991, Mosby, with permission from Elsevier.

External visual inspection: Inspect the pinna and the area around it for any abnormalities such as preauricular sinuses, skin tags, or atresia. Check for set/tilt (position) of the ears (see image to the right), tenderness, redness or edema, signs of drainage, foul odor, wax build-up in the outer third of the canal, or dermatitis.

Internal visual inspection: With the otoscope inspect the ear canal and tympanic membrane for signs of drainage, wax build-up, or damage to the ear canal. Also note whether normal landmarks on the tympanic membrane can be seen. Internal visual inspection should only be performed by screeners with training and experience.

Pass/No Pass Criteria: Normal appearance of all structures and no complaints of pain when the pinna or the tissue around the ear is manipulated (see Interpretation of Results).

Question: Do you know why children are more susceptible to ear infections (also called otitis media) than adults?

Click here for the answer.


This ends the External/Internal Visual Inspection of the Ears part of the Screening Procedures Section. You may return to the Table of Contents or continue with the next part, Documentation.


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