Pneumatic otoscopy requires a cooperative patient, which is why it is not very used in the the majority of small children. It requires a lot of practice which is another reason why it is not used much. Noting that small movement of the tympanic membrane with insufflation is very difficult to see in a child that is squirming and moving around. It is also not reimbursable. I prefer to use tympanometry which prints out the pressure differences and can be compared on the follow-up visit. The printed tympanometry is my documentation that the test was done.
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