Ear Wax

A 9-year-old female presents to the general pediatric clinic in the summer for a routine checkup. She has no specific complaints. Examination of the right ear with the Wispr Digital Otoscope reveals this image.

What is the next step in management?

1. No action is necessary, the ear is normal.
2. A better view of the ear drum should be obtained.
3. Begin a course of antibiotics for otitis externa.
4. Referral to otolaryngology (ENT)

Answer: B. A better view of the ear drum should be obtained.

The image shows only cerumen (ear wax). It is not possible to form an opinion of the eardrum, normal or not, from this image. This view is often seen with traditional analog otoscopy – that is, nothing is seen but wax that is occluding the eardrum and preventing evaluation. Otitis externa (swimmer’s ear) can look like cerumen. However, with otitis externa, there would be symptoms such as ear pain. The patient in this vignette has no symptoms to suggest otitis externa.

Because of the unique geometry of the WiscMed Wispr speculum combined with the distally mounted camera, it is often possible to maneuver around the ear wax and obtain a view of the eardrum. Here is a still image of the normal eardrum after using the Wispr to navigate past the wax.

This ability of the Wispr Digital Otoscope to maneuver around wax may increase the speed and comfort of the examination as there is often no requirement to remove ear wax.