Gene McHugh, EdD, Audiologist

Colorado Springs Audiology, Inc.


Originally Published, 2012, Updated 2021




     Since 1993, I have been using otomicroscopy for routine ear exams and cerumen removal.   My first binocular microscope was a "used" wall-mounted Zeiss scope, purchased from Prescott's, Inc.  The microscope was relatively 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 mypatients.


     HISTORY:  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  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. I finished the procedure without causing too much discomfort on the part of my opera star, and then and there decided I needed better equipment, 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 using a binocular microscope and to Prescott's microscopes located in Monument, Colorado.    


      As most fellow audiologists remember, in 1993 video-otoscopy (VO) was being heavily marketed to audiologists and hearing aid specialists (still is!). There were exceptional articles on the benefits of VO (mostly by Sullivan, 1993); and many colleagues had VO so I requested a demonstration.  I thought video-otoscopy provided excellent illumination and magnification of the canal and TM, along with outputting a handy color picture, but in my opinion was terrible with respect to earwax removal. 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 along with the hands-free ability to ear my patient's ears, the decision on the most effective method for exams and CM was clear. 


      I have been using an operating microscope on my patients for over 25+ years and believe it to be an excellent 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.


      I 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. 


     FINAL NOTE:  Ten years after I wrote this initial article and posted it on my web site, almost nothing in audiology has changed.  Except very a very few, most audiologists still use simple otoscopes to clean ears and plod along as I did before getting my microscope.  The claim is the equipment is too expensive and audiologists don't make enough doing ear cleanings to justify the cost.  I find this argument repulsive.  The fact is, patients recognize the difference in my ability compared with other professional audiologists as well as ENT's.  I use the microscope for all hearing aid patients to keep their ears as clean as possible.  I do not worry about getting paid.  It's the service that's what's important. 



   Academy of Dispensing Audiology (1991).  Cerumen Management Seminar.  ADA Feedback, 2(4):7.

   American Speech-Language-Hearing Association (1992).  External auditory canal examination and cerumen management.  ASHA, 34. 22-24)

   Ballachanda, B. (1995).  The Human Ear Canal.  Singular Publishing Group, San Diego.

   Chaiken, R. (2000).  Issues in Cerumen Management.  Audiology Online.  

   Courtois, J. (1999) Earwax and foreign bodies in the ear canal.  Available through Widex.

   CASLPO, 2005.  Preferred Practice Guidelines for Cerumen Management, College of Audiologists and Speech-Language Pathologists of Ontario.

   Gleitman, R.M., Ballachanda, B.B. & Goldstein, D.P. (1992).  Prevalence of cerumen impaction in the general population.  The Hearing Journal, 45, 28-32.

   Purdy, J. (2002).  Managing CerumenAudiology 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, 44(8), 447-467.