If you’ve ever seen an audiologist before, you’ll know that the first thing they do after taking your history is look in your ears. We’ve heard many patients make a joke about being able to see all the way through and out the other side! But what exactly are we looking for? What do audiologists see when they look into an ear?

How we look

Audiologists (and doctors) use a tool called an Otoscope to look into a person’s ear. This handy tool is like a combination of a torch and a magnifying glass. It shines a light into the ear canal, illuminating anything inside, and make it big enough that we can examine it and identify the structures. Some otoscopes can connect to screens that allow us to ‘zoom in’ to what we see.

Why do we look?

Before starting any hearing assessment, it’s important to know what’s happening in the outer and middle portions of the ear. If there is anything blocking the ear, like a foreign body or wax, this needs to be removed before the hearing test can take place. We are also looking for clues about the health of the eardrum and middle ear. Anything that looks abnormal may have an effect on the results of the hearing assessment and should be noted before the test begins.

What are we looking for?

When an audiologist looks into your ear, they are also having a look at the outside of the ear. We check that the pinna, or the outside, visible ear, is normal, or if it is injured or damaged in some way. We then look at the ear canal. Is it fully open and dry? Or is it blocked by wax, a foreign body, or anything else? The final thing we look at is the eardrum. Is it intact? Are there any visible perforations? Does the ear drum look pearly or dull? Is it dry or does it appear wet? Is it bulging out, or sucking back in to the middle ear? All of these things can help us to understand what is going on with the ears and therefore what is going on with the hearing. We then use this information, as well as the results of the tests we perform, to make recommendations about what you should do next.

What does a healthy ear look like?

A healthy outer ear should have a firm pinna without any injury or inflammation. The ear canal should be open, dry, and may have some wax, but this shouldn’t block the ear. The eardrum should be intact and have a pearly appearance like the skin of a drum. We should see the top of the first middle ear bone, the malleus, visible at the top of the drum, but this shouldn’t be bulging through excessively. If you’ve had a perforation before, or if you’ve had middle ear surgery, we may see scar tissue and may even see a healthy perforation or a grommet in your ear. This doesn’t mean that the ear is not healthy, but it is the exception and not the rule.

What happens if the ear doesn’t look healthy?

If the outer ear appears inflamed or infected, we may ask you to see an Ear, Nose and Throat specialist before we continue with the hearing test. If the ear is blocked by anything, this will also need to be removed. The exception to this is when the ear canal is blocked by it’s own skin or by a narrowing of the ear canal. The hearing test can be completed, but the patient’s hearing will almost definitely be affected, and they should see a specialist after this. If there is fluid in the ear canal, or a visible wet perforation, the test will also be stopped until the ear is healthy, unless the test is requested by the ENT specialist. Finally, if the ear canal is clear, but the eardrum has scar tissue, an old perforation, or is retracted, we may continue with the test but ask you to see a specialist afterwards. Your audiologist will be able to guide you on what’s best for your ears.

Can I look in my own ear?

While there have been developments in video otoscopes that allow people to shine a light into their own ears, it isn’t recommended that a lay person try to assess their own ear canals and drums. Audiologists and doctors have many years of experience evaluating the structures of the outer ear and eardrums. They are more likely to be able to get a good angle and are more likely to be able to identify anything abnormal. If you want to know what’s happening inside your ears, it’s best to make an appointment to see a doctor or an audiologist.

If you want to know more about the inside of your ears, or if you would like to make an appointment, contact us or comment below.