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Middle-Ear Problems in Childhood

Francis W. Davison, MD
JAMA. 1966;196(10):834-838. doi:10.1001/jama.1966.03100230078020.
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Before discussing some of the disease entities encountered in children, I would like to comment on methods of examination. If one is to have any concept of what is taking place in the middle ear, he must be able to visualize accurately the tympanic membrane. The best source of illumination is a head mirror or preferably a head light, which can be worn over one eye to provide axial illumination. Use of the head light leaves the examiner with two hands unencumbered, one to use the speculum with a magnifier ( ×2) attached and the other hand free to use a curette for removing wax or semisolid debris. If there is fluid exudate, it can be removed with a cotton-tipped applicator or preferably a No. 15 gauge aspirating tip if suction is available. The examiner should select the largest size speculum which will fit comfortably in the ear canal. The magnifier


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