Companies that sell and service microscopes
are recognizing private practice
audiologists, while not a large group as
compared with ENT or dentistry, represent
an excellent opportunity for additional
sales. As marketing actively increases in
our field, it is expected the use of simple
otoscopes and video-otoscope systems will
decline in favor of superior equipment.
Dr. McHugh is an unpaid consultant with
MAKING THE TRANSITION
TO OTOMICROSCOPY AND LEARNING A NEW SYSTEM
Transitioning to the stereoscopic (or binocular) microscope
takes a time to get used to, but should be relatively easy for
practitioners already skilled at CM. Simple otoscopy and
video-otoscopy offer only one dimension thereby limiting depth
perception, whereas loupes and microscopy provide three
dimensional acuity. Ocular loupes demand the clinician use
convergent vision to overlap two images. This is not as
clear as microscopy and causes more eye strain as magnification
increase. In the operating microscope, the clinician
adjusts the binocular lens and looks straight ahead with clearer
magnification without eye strain. Since most audiologists were not
trained using the microscope, understandably, new users may be
intimidated. New users tend to over-correct their vision
when first looking the the microscope rather than relax and look
straight on. With practice, depth perception improves in a
short period of time. Also at time, a few adjustments in
the scope's lens are necessary by the manufacturer's
representative. If you are
interested in transitioning to a microscope in your audiology practice, feel free to contact me personally
by phone (719)520-1155 or by e-mail at
INCLUDING OTOMICROSCOPY IN
provide instructors and supervisors with a very effective method
to instruct students. Instructors are able to easily
demonstrate anatomy, physiology and cerumen removal technique.
Moreover, this can allow instructors to watch and guide
students for more effective training of ear examinations and CM
Since 1993, this office has been
using otomicroscopy for routine ear exams and cerumen
Our first "used" wall-mounted microscope, purchased from Prescott's,
Inc. was very affordable when compared to other
audiologic equipment in our clinic and relatively easy
to use. It now seems inconceivable to use anything
but a microscope for CM on our patients.
It started in 1993. I
was cleaning the ears of a local opera celebrity
being extra careful, in part because of his
notoriety. I was using my best eye to look
through my handy Hotchkiss otoscope (dealing with the
"fair" at best, illumination and magnification)
while having to position the scope with my left
hand so I could remove cerumen with my right. It
was not easy and in my opinion, the reason was
inferior equipment. I finished the
procedure without causing too much discomfort
for my opera star, but decided I needed
better illumination and magnification along
with a hands-free system to perform cerumen
removal. Fortuntely, I had a
neuro-otologist friend who directed me to
Prescott's microscopes in Monument, Colorado.
As most fellow audiologists remember,
1993 video-otoscopy (VO) was being
heavily marketed to audiologists and hearing aid
specialists (it still is!). There were exceptional articles
on its benefits (Sullivan, 1993); and many colleagues had
VO so I requested a demonstration. I
thought that video-otoscopy
provided excellent illumination and
magnification of the canal and TM, along with
outputting a handy color picture (that helps
with hearing aid sales), but in my opinion
was nearly useless with respect to CM. I discussed
my dilemma with local otologist David
Barrs who recommended I get a microscope rather
than a video-otoscope. Once I was able to
view an ear canal through a binocular
microscope with its excellent - fiber optic- illumination and
magnification, the decision on the most effective
method for exams and CM was clear. Most of all, both hands
were free to work.
I have been using an operating
microscope on my patients for over 25+ years and believe it to be
investment considering the potential liability associated with
CM. Patients are more comfortable, my visual accuracy
significantly enhanced, and the hands free operation while
cleaning ears indispensable. Prior to every hearing
test, my patients have completely clear ears.
Rarely do I have to refer out any
patients to ENT because of earwax issues.
Upon Dr. Barrs' recommendations, I purchased a
"used" Zeiss Opni-9 microscope from Prescott's
Microscope located a few miles north of Colorado
Springs, CO where my practice is located. The cost was $4500.00 when I
bought it. Interestingly, at the same time, video-otoscopes
were running between $8.000.00-10,000.00.
Ironically, the microscope was more affordable.
In 2008, I traded my 15 year old "used"
microscope (that has needed little or no
servicing) for a new Omni-10 with S-Video output
to a 45" Flat Screen TV. The cost was
slightly more than $10,000.00. In 2016, I
upgrade to high definition video. Wow! The
addition of the HD video has been an excellent
source of patient and staff education.
have often wondered why oto-microscopy is not
incorporated into most audiologist's offices. I
have come to believe the reason is "fear of the
unknown," especially as it relates to many of the
instructors in our training institutions. It is my opinion that once
practicing audiologists are given a good "hands-on"
demonstration with a microscope, learn of the relatively
affordable price and given a couple of pointers on using the
microscope, the operating microscope will hopefully merge as a standard
piece of equipment in the average audiology office.
Dispensing Audiology (1991). Cerumen Management
Seminar. ADA Feedback, 2(4):7.
Speech-Language-Hearing Association (1992).
External auditory canal examination and cerumen
management. ASHA, 34. 22-24)
(1995). The Human Ear Canal. Singular
Publishing Group, San Diego.
in Cerumen Management. Audiology Online.
J. (1999) Earwax and foreign bodies in the ear
canal. Available through Widex.
Preferred Practice Guidelines for Cerumen Management,
College of Audiologists and Speech-Language Pathologists
Ballachanda, B.B. & Goldstein, D.P. (1992).
Prevalence of cerumen impaction in the general
population. The Hearing Journal, 45, 28-32.
Managing Cerumen. Audiology Online.
Sullivan, R (1993) How video otoscopy benefits
hearing health care practice. Hearing
Instruments, 44(4), 15-18.
Sullivan, R. (1997). Video Otoscopy in Audiologic
Practice. J. Am Academy of Audiology,
COLORADO SPRINGS AUDIOLOGY, INC