Assessing middle ear disease: beyond visual otoscopy.

Visual otoscopy, the first step in the diagnosis of middle ear conditions, permits an assessment based on the color and appearance of the tympanic membrane. With pneumatic otoscopy, the mobility of the tympanic membrane can be evaluated. Several other techniques can be used to augment visual and pneumatic otoscopy. Impedance tympanometry provides an objective record of tympanic membrane movement. The acoustic otoscope evaluates middle ear contents by the reflectivity of sound from the tympanic membrane.