Tympanic Membrane Assessment

Examination Techniques

Pneumatic otoscopy is the gold standard for tympanic membrane examination, creating an air-tight seal in the ear canal and using a rubber bulb to change pressure to assess membrane mobility 1
A normal tympanic membrane moves briskly with applied pressure, while movement is minimal or sluggish when middle ear fluid is present 1
Careful examination should specifically search for retraction pockets, ossicular erosion, and areas of atelectasis and atrophy 2
Otomicroscopy provides a magnified binocular view with good depth perception when there is uncertainty about normal structures 1, 2
Tympanometry offers objective measurement of middle ear function by creating graphs showing how energy is reflected while canal pressure varies from negative to positive 1, 3
Standard tympanometry uses a 226 Hz probe tone for adults and children over 6 months, while 1,000 Hz is more appropriate for infants under 6 months due to their naturally stiffer tympanic membranes 3

The normal tympanic membrane appears pearly gray, translucent, and has good mobility when assessed with pneumatic otoscopy 1, 4
Normal mobility is a key distinguishing feature from conditions like acute otitis media where mobility is limited or absent 4
The resonance frequency of a normal tympanic membrane typically ranges from 226 Hz to 1,000 Hz 3

A bulging tympanic membrane is most useful for diagnosing acute otitis media 1
In acute otitis media, the tympanic membrane appears distinctly erythematous, bulging, and cloudy with limited or absent mobility 4
An opaque or cloudy tympanic membrane is most useful for diagnosing otitis media with effusion 1
Tympanometry typically shows a flat tracing (Type B) in otitis media with effusion 4
Children with chronic otitis media with effusion are at risk for structural changes of the tympanic membrane due to inflammatory mediators 2

Record the status of the tympanic membrane separately from ear canal findings 4
Document whether the tympanic membrane is fully visualized, partially visualized, or not visualized due to canal edema 4
Note the mobility of the tympanic membrane if pneumatic otoscopy was performed 4

Increased stiffness of the tympanic membrane can lead to conductive hearing loss by impeding sound energy transmission to the middle ear ossicles 3
Visualization of the tympanic membrane may be difficult due to ear canal edema and discharge, potentially requiring gentle cleaning before adequate assessment 4