How to examine the ears with an otoscope
Other platforms explain it with text and video. In VMS you practice it on the patient.
A safe otoscope exam depends on two things: bracing your hand against the patient's head, and pulling the ear the right way for their age.
Step by step
Prepare
Clean your hands, introduce yourself, get consent and ask about pain, discharge and hearing loss. [1]
Outer ear
Look at the ear and the bone behind it. Gently move the ear and press the tragus: pain suggests an outer ear infection. [1]
Hold the otoscope
Largest speculum that fits. Hold it like a pen with the side of your hand resting on the patient's head so it moves with them. [1]
Straighten the canal
Adults: pull the ear up and back. Young children: down and back. [1]
Look at the canal
Wax, redness, swelling, discharge or a foreign body. [1]
Look at the eardrum
Normal is pearly gray and see-through with a cone of light. Note redness, bulging, fluid behind it or a hole. [1]
Hearing tests
Whisper test, then a 512 Hz tuning fork: Weber on the top of the head and Rinne beside the ear compared with behind it. Normally air is heard longer than bone. [1]
Common errors
- Not bracing the hand (the scope can hurt if the patient moves).
- Pulling the ear the wrong way for the age.
- Using a 128 Hz fork for hearing (it is for vibration).
Practice it in VMS
In VMS you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.
VMS cases that train this skill
Sources
Steps adapted from Open RN, Nursing Skills 2e (Chippewa Valley Technical College), licensed under CC BY 4.0. VMS is not affiliated with these organizations. Updated: 2026-10-11.