Behind tympanic membrane for any visible features (pars tensa, pars flaccida, handle/lateral process of malleolus, cone of light)
Slowly withdraw the otoscope
Dispose of speculum in clinical waste bin
Crude hearing test
Ask patient to occlude one ear. Whisper a number, starting peripherally and then moving closer towards their ear. Ask them to tell you the number when they hear it. Repeat on other side.
Use a 512Hz tuning fork. Twang the prongs and place the round base of the fork on the patient’s forehead between their eyes. Ask them if one side is louder than the other(if one side is louder, either that side has a conductive deficit, or the contralateral side has a sensorineural deficit – Rinne’s test can then determine which).
Use a 512Hz tuning fork. Twang the prongs and place the round base of the fork on the patient’s mastoid process. Ask them to tell you when the sound stops. Then, place the prongs near the patient’s ear. Ask them if they can then hear it again – air conduction should be louder than bone conduction (if they cannot hear it, there is a conductive deficit in that ear).
Test facial nerve function if serious pathology observed
Summarise and suggest further investigations you would consider after a full history (e.g. audiometry, tympanometry)