Otoscopy Instruction - Phonak Lyric2 Instruction Booklet

14

Otoscopy instruction

Before starting otoscopy, make sure the chair and the
microscope are properly set up for the patient and the
microscope is adjusted correctly. Refer to the "Lyric2 work
environment set-up instruction" (see page 10) for support.
Goals
‚ Make sure the ear canal is clear from cerumen.
‚ Make sure the patient's skin condition is good and the ear canal
is healthy.
‚ Visualize the outer ear and the complete ear canal including
the tympanic membrane (TM) to identify any contraindications
or ear canals with an inappropriate geometry (candidacy
checklist on page 12 for details).
‚ Develop the "flight path" during ear canal visualization prior
to inserting a Lyric2 sizer and device due to the need to work
blind during insertion.
‚ Prior to Lyric2 refits, it is important to visualize the ear canal
with a microscope to identify any ear canal abnormalities and
to make sure the ear canal is free from cerumen.
Perform otoscopy
‚ Otoscopy is performed slowly and systematically from outside
to inside. Start at the concha bowl through the ear canal opening
visualizing the entire ear canal and then the entire tympanic
membrane.
‚ Start with the biggest speculum. Change to smaller speculum
if necessary in order to get a good view of the entire canal and
the TM.
‚ Crucial checkpoints are the first and second bend (where device
will need to turn), the bony cartilaginous juncture, the medial
seal location (4 mm from TM) and the TM itself.
‚ To improve view, change position of the patient's head, e.g. if the
ear canal has a rise, tilt the head of the patient away from you;
if you want to see the posterior wall of the ear canal turn the
patient's head towards you.
‚ Check jaw movement during otoscopy, looking for the anterior
bulge of the jaw joint. If the bulge enters the canal, set realistic
expectations regarding comfort and migration issues.
‚ If there is any cerumen present in the ear canal, or if any
abnormalities are detected, refer patient to an ENT to remove
cerumen/have abnormalities assessed.
Further tips
‚ Explain the otoscopy process with the patient.
‚ Maintain a relaxed seating position.
‚ Hold the speculum with thumb and index finger and brace your
hand at the patient's head.
‚ Straighten ear canal by pulling pinna backwards and up.
‚ Straighten ear and check if TM is visible (without speculum).
If it is visible, the ear canal is fairly straight which is a good
pre-condition for Lyric2.
‚ All wax/debris must be removed from the canal prior to fitting.
With insertion of Lyric, any wax that is in the canal will be
pushed medially.
‚ For Lyric2 refits, always ensure that the ear canal is healthy and
free of cerumen and debris.
‚ Some patients might not feel discomfort or pain despite having
ear health issues. It is very important to rely on thorough
otoscopy and to refrain from fitting Lyric2 for the time being if
any abnormalities are visualized.
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