Summer seems like its almost here! In my peds office, we're seeing fewer patients overall, but still a fair number of viral infections and ear infections, especially in the little kids. For those infants who come in with complaints of "he won't sleep" or "fussy" and "fever and runny nose", its important to separate the treatable conditions from the viremias and teething issues. To do that you've GOT to visualize the ear drum adequately to rule out or in otitis.

For the little kids, my best tip is to do everything with the child held on mom's shoulder. Mom should be backed up against the table for support, and she holds the child in the "L" formed by her shoulder and neck. The babies turn their heads out-ward automatically. I use the heel of my hand to immobilize the child's head (or at least keep them from turning), and my thumb and finger to extend the ear and straighten the ear canal. If there's wax, I like the white FlexLoop or lighted VersaLoop, depending on the size of the ear canal and how well I can see. Usually I can remove enough wax to make my diagnosis in a relatively quick and painless fashion. Being able to confidently tell the parent that there's NOT an infection because you got a good look at the ear drum is worth its weight in suckers!

Any tips you have for examining kids (or adults) and ear wax removal would be appreciated by all.

Till then.

James Huttner MD