Hearing Screening E-Learning Course

Hearing Screening E-Learning Course

Visual Inspection of the Ears


All Ages


To check for signs of ear disease or abnormal development


A systematic inspection of the external ear canal, surrounding tissue, ear canal, and tympanic membrane


Visual inspection should be conducted in a well-lighted area


External inspection: Adequate lighting

Internal inspection: Otoscope

If the screener has training and experience in using an otoscope. If the screener lacks training and experience in using an otoscope, the visual inspection should be limited to the external aspect of the ears.

Normal ear position

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: Inspect the pinna and the area around it for any abnormalities such as preauricular sinuses, skin tags, or atresia; check for position (set or tilt) of the ears, tenderness, redness or edema, signs of drainage, foul odor, wax build-up in the outer ear canal, or dermatitis. Refer to the MDH Otoscopy and Tympanometry Manual for pictures and more information.
Internal: With the otoscope, inspect the ear canal and tympanic membrane for signs of drainage, wax buildup, foreign bodies, redness of the ear canal, and other abnormalities; note presence or absence of normal tympanic membrane landmarks.


Children with normal appearance of all structures and no complaints of pain in the pinna or the tissue around the ear do not require referral.


Refer children with any abnormality to a medical provider. Do not proceed with audiometer screening if tenderness, signs of drainage, or foul odor is present; this should be an automatic referral. For complete information on documentation, refer to the C&TC Documentation section.

Note: You must answer the following questions to continue with the course.

Question: The screener should perform an audiometric screening on a child even if there is foul drainage or pain present in the child's ear(s).

This concludes the Visual Inspection of the Ears segment of the Hearing Screening Procedures section. You may return to the Table of Contents or continue with the next segment, Pure Tone Audiometry Screening. If you do not plan on completing the entire web training, please fill out the evaluation form, C&TC Children's Hearing Screening Web-Based Training Evaluation.

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