Gene McHugh, EdD, Audiologist
Originally Published, 2012, Updated 2021
I have been
using otomicroscopy for routine ear exams and cerumen
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.
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,
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
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
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.
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
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