During an ear examination, the doctor looks inside your ear using an instrument called an otoscope.

The health care provider may dim the lights in the room.

A young child will be asked to lie on his or her back with the head turned to the side, or the child's head may rest against an adult's chest.

Older children and adults may sit with the head tilted toward the shoulder opposite the ear being examined.

The health care provider will gently pull up, back, or forward on the ear to straighten the ear canal. Then, the tip of the otoscope will be placed gently into your ear. A light beam shines through the otoscope into the ear canal. The health care provider will carefully move the scope in different directions to see the inside of the ear and eardrum. Sometimes, this view may be blocked by earwax.

The otoscope may have a plastic bulb on it, which delivers a tiny puff of air into the outer ear canal when pressed. This is done to see how the eardrum moves. Decreased movement can mean that there is fluid in the middle ear.

No preparation is needed for this test.

If there is an ear infection, there may be some discomfort or pain. The health care provider will stop the test if the pain gets worse.

An ear exam may be done if you have an earache, ear infection, hearing loss, or other ear symptoms.

Examining the ear also helps the health care provider see if treatment for a certain ear problem is working.

Everyone's ear canal differs in size, shape, and color. Normally, the canal is skin-colored and has small hairs. Yellowish-brown earwax may be present. The eardrum is a light-gray color or a shiny pearly-white. Light should reflect off the eardrum surface.

Ear infections are a common problem, especially with small children. Middle ear infections may be present if the light reflex is dull or absent. The eardrum may be red and bulging. Amber liquid or bubbles behind the eardrum are often seen if fluids collect in the middle ear.

An external ear infection may be present if the ear canal is red, tender, swollen, painful when wiggling or pulling on the outer ear, or if the canal is filled with yellowish-green pus.

Additional conditions under which the test may be performed:

• Cholesteatoma
• External ear infection - chronic
• Ruptured or perforated eardrum

If the instrument used to look inside the ear is not cleaned properly, an infection can be spread from one ear to the other.

Not all ear problems can be detected by looking through an otoscope. Additional ear and hearing tests may be needed.

Otoscopes sold for at-home use are lower quality than the ones used at the doctor's office. Parents may not be able to recognize some of the subtle signs of an ear problem. If there are symptoms of severe ear pain, hearing loss, dizziness, fever, ringing in the ears, or ear discharge or bleeding, see a health care provider.

Murr AH. Approach to the patient with nose, sinus, and ear disorders. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders; 2007:chap 452.