Help otoscope exams for young children.

[VFCnurse]

I am a fairly new school nurse at a child care center and I am having a difficult time with ear assessments with otoscopes. I know what to look for however I feel as if I really can not tell if there is an infection going on. Any tips or advice out there. Thanks

[mustlovepoodles, RN]

i don't do otoscope exams. It doesn't matter if I can recognize an ear infection or just fluid, it's not my call to make. If a kid is c/o ear pain and it's bad enough to keep them from participating in class, I call home and let parents decide whether to go to the doctor or not. Certainly, if the complaint goes on for 2 or more days, i will take a firmer stand with the parent.

[safarirn]

I was never trained in Nursing School on how to assess for an ear infection using an otoscope... so that is out of my scope of knowledge.

[Flare, ASN, BSN]

Mostly use otoscope to assess obvious s/s infection like redness or for obvious injury. Most complaints that i get ( from middle schoolers) is discomfort due to impaction of cerumen. Also helpful when screening hearing if students show slight abnormality to see if there is an impaction.

[mycsm]

If you are not sure, dont do it, it could back fire.if the child is in pain, call the parents and "suggest" the child get checked. I usually say (unless they have a fever), he is experiencing pain and could use an evaluation with MD AFTER school. I ahve been trained to look and if I cannot see past the cerumen build up, I chalk it up to wax in ear. However if there is a good clear shot of ear canal, you will see a pearl colored shiny drum. If extremely red/pink, I call parent.

[Purple_Scrubs, BSN, RN]

I only use my otoscope to help decide how urgently the parent needs to take the kiddo to the doctor. If the child c/o mild pain, but I see a normal appearing ear, or simply a lot of wax, and the child is not in distress, I usually recommend the parents keep an eye on it for a day or so, but if the pain continues they should take him/her in. If there is redness, inflammation, fluid, or other signs of infection, I recommend they go ahead and take the kid in as soon as they can get an appointment.

[Jolie, BSN]

I always ask the child if it is OK to use my special flashlight to look into their ears. They almost always say, "OK." Then I simply describe to the parents what I see, such as "the ear canal is almost completely occluded with dark, flaky wax", "reddened, swollen ear canal", "bulging tympanic membrane with bubbles visible", or "tympanostomy tube which appears to be dislodged and embedded in wax".

I stress to them that only a physician or APN can make a diagnosis, but based upon what I've seen, may recommend making a phone call to the doctor's office or offer information on how to safely clean wax from the ears. It's always interesting to me to learn whether or not they were aware of the dislodged ear tubes.

[Spidey's mom, ADN, BSN, RN]

I just returned from my audiometry class.

The teacher stressed it is not in our scope of practice to diagnose.

PLUS - even pediatricians cannot tell if a child has a TRUE infection just by looking with an otoscope.

One way to ID problems with the eardrum and middle ear system is the use of a tympanometer. A school nurse who has been trained can do this but not interpret it - a referral to an audiologist must be made.

So, a child's parent must be told about symptoms and then a medical referral is made.

According to the instructor anyway. . . . .. . . I'm new at all this stuff.

steph