Red Flags

Some of the conditions or problems that can be identified by the otoscopic examination follow. DO NOT make ear impressions without medical clearance if any of these are present.

Impacted Cerumen
Wax can range from wet to dry in character. When wet, it can be yellow, brown or reddish in color. Dry wax appears as flaky scales in the outer ear and canal. If either type is present in quantity, the patient should be referred to an otologist to have the cerumen removed. In many states, it is illegal for anyone other than a physician to remove cerumen.

DO NOT attempt an ear impression if there is excess wax. You could permanently damage the eardrum if you push wax onto or through it. Also, too much wax will result in an inaccurate impression and a badly-fitting earmold.

This involves the partial or complete closing of the ear canal. Do not proceed on a patient with atresia without medical clearance.

Aural Discharge
Occasionally there may be fluid running from the ear canal, often accompanied by a noticeable odor. Presence of any liquid or odor should be a red flag to the fitter, and the patient should be immediately referred to an otologist. Likewise, any growth in the ear canal must be medically treated.

Bony Growths (Exostoses)
Any bony growth is cause for referral to an otologist.

Inflammatory Conditions
In the outer ear, a bacterial or fungal infection (External Otitis) in the ear canal may make the ear red and sensitive. A pimple in the pinna or ear canal may also be sore. Both require medical attention prior to making an impression.

Otitis Media, or fluid behind the eardrum, often causes the drum to be ballooned out. Medical management is essential, and medical clearance required, before an impression can be taken.

Foreign Objects
If the otoscopic inspection reveals a strange color or shape, there may be a foreign object lodged in the ear canal. Examples include erasers, insects, sand, cotton, peas, etc. Medical referral is necessary.

Eardrum Retraction
When middle ear problems cause Eustachian tube dysfunction, normal pressure equalization of the drum does not occur. Abnormal middle ear pressure can cause the eardrum to retract and stretch back over the ossicles. Medical management is essential.

Eardrum Perforation
Any hole or tear in the eardrum is cause for referral to an otologist.

Ventilating Tubes
Ventilating tubes are commonplace in treating otitis media. They are usually instantly visible by their color. Medical clearance is required before taking impressions of ears with tubes in the drums.

If you are ever uncertain about anything that does not look "just right," or that you do not understand, REFER. If you err, always err on the safe side.

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