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Put a new speculum, or pointed end, onto your otoscope before each patient. Select the largest possible speculum that your patient’s ear will accommodate. When inserted, the speculum should fit snugly into the outer third of the ear canal. Speculums that are too small can cause discomfort and reduce how much of the ear you can examine. Use the following guidelines for speculum size:  Adults: 4 to 6 millimeters Children: 3 to 4 millimeters Infants: as small as 2 millimeters Without using the otoscope, take a look at the person’s external ear and notice any redness, discharge or swelling. Manipulate the ear gently and ask the patient if there is any pain. With Swimmer’s ear there is often pain, swelling, redness, and discharge that can be observed before even using the otoscope. Place the otoscope at your patients ear, not in it. Look into your otoscope and then slowly insert the pointed end of it into the ear canal. Steady your hand on the side of the individuals face if necessary. Slow and gentle insertion can prevent unwanted movement in your patient. It also keeps your hand and scope in line with the ear and minimizes the risk of injury. Avoid putting too much pressure on the otoscope, which can bump the inner canal wall, causing the patient discomfort. Avoid ramming the speculum into the ear canal. Insert it at most 1 to 2 centimeters and then use the light to view beyond the tip of the speculum. Stop the examination immediately if the patient expresses any pain or discomfort. Examine the middle ear and eardrum. Angle the tip of the otoscope towards the person’s nose. This follows the normal angle of the ear canal. From here, move the otoscope gently at different angles. This allows you to view the person’s eardrum and canal walls. Stop the exam at any sign of increased pain or discomfort. Return the otoscope back to your starting position. As you watch through the speculum, gentle take the speculum and scope out of the person’s ear canal and outer ear. Release the person’s ear from your grasp. Remove the speculum from the otoscope. Throw it away in a certified medical waste container to minimize the spread of disease or infection to other patients. If you don’t have disposable speculums, scrub each tip with hot water to remove excess wax. Then soak the speculum in a covered dish of rubbing alcohol for 10 minutes.
Choose the right speculum size. Examine the external ear first. Insert the otoscope slowly into the ear canal. Push the speculum 1 to 2 centimeters into the canal. Angle the otoscope. Remove the otoscope. Throw away the speculum.