to the editor: The cover illustration on the December 1, 2007, issue of AFP unfortunately demonstrates poor technique in the use of the otoscope to examine the child's external ear canal and tympanic membrane. As illustrated, the technique risks irritation and injury to the external ear canal from the tip of the otoscope speculum if the child moves her head toward the examiner. The examiner should apply a small amount of traction to the ear lobe with the right hand to straighten the external canal. The otoscope should be held in the left hand with the fifth finger stabilizing it against the head to maintain proper position when the child moves her head, as they almost always do. The hands should be switched when examining the right ear, but stabilizing the instrument against the child's head is mandatory.

I have seen too many students, residents, and nurse practitioners examine children's ears using the technique illustrated on the cover and on the first page of this article. I would conclude that they are not being taught how to use an otoscope safely and correctly. Certainly a high quality journal such as AFP that is being read by thousands of physicians should not compound this problem.

editor's note: Dr. Markman's critique of the inappropriate ear examination technique depicted in the December 1, 2007, cover illustration was echoed by several other readers. We agree that in this case artistic license should not have been taken with an important examination maneuver and we apologize for the oversight.