Adequate illumination of the TM requires proper lighting and an open ear canal, but cir- cumstances are seldom optimal. As many as one-third of physicians treating AOM have reported changing otoscope bulbs less often than recommended, and in one-third of oto- scopes the light output has been inadequate (Barriga et al. 1986). Children’s narrow ear canals are easily obstructed by cerumen, which compromises visualization. Cerumen removal is necessary in about 30% of children with AOM, and even more often in infants (Schwartz et al. 1983). Even despite an insuffi cient view, cleaning of the ear canal is frequently ignored (Jensen and.
