It is not until age 3 that a normal child's eardrum resembles that of an adult. In neonates the pars flaccida is more a block of mesenchyme than a membrane, explaining the lack of movement when the baby cries. The mesenchyme explains the redness and opacity of the neonatal drum.
For examination the child should sit on an adult's lap, sideways for examining the ears. Both hands should be secured by the adult with one hand, the head held firmly against the chest with the other.
The otosope should be held lightly, like a pencil between thumb, index and middle fingers. The little finger can be rested on the forehead, adding the examiner's proprioception to the senses used in completing this delicate exam. Thus, if the head moves, the otoscope moves too, not knocking the meatus or drum, which are exquisitely sensitive.
It may be possible to introduce the suggestion that the examination may well tickle, especially in children over three years. Other siblings can be distracted by asking them to look for the light coming out of the other ear. It is remarkable the difference that these comments make to the cooperation and overall enjoyment of the examination - for both child and doctor.
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