Sir, oral examination for patients with limited oral opening presents considerable technical challenges to the examiner and can be an uncomfortable process for both examiner and patient. Most overhead or floor lights do not permit adequate examination, and headlights and mirrors, while offering more positioning flexibility and preserving hands-free feature, do not accommodate patients with more challenging oral features. Penlights can be helpful, but most are too dim and do not direct light well enough for considerable clinical use. Some clinicians have seen the benefits of using diagnostic otoscopes, which solve many of the above technical problems of examination and have the added benefit of magnification (Fenton S A. Personal communication. July 2009). Use of diagnostic otoscopes, which have a closed head not that does not permit bi-directional airflow, is limited by fogging of the lens.

Use of an operating otoscope, which has an open head and is less prone to fogging, eliminates all of the above challenges. Operating otoscopes may be used for oral examination with or without speculum attached (Figs 1 and 2). If hands-free use is required and the patient is to remain in one position for a prolonged period, a vice clamp and c-arm extension could also be used, but we have not found this necessary. Use of an operating otoscope for oral examination is the standard technique employed for all patients in our group, irrespective of oral opening.

Figure 1: Operating otoscope with speculum attached.
figure 1

While the light distribution is narrow, light is sufficient when using the magnification lens and if doing ear examination, there is no interruption of the examination process to remove the speculum

Full size image
Figure 2: Operating otoscope without speculum attached.
figure 2

Without the speculum attached, the entire oral cavity is easily illuminated

Full size image