Combination otoscope

• US 20030171655A1
• Filed: 03/08/2002
• Published: 09/11/2003
• Est. Priority Date: 03/08/2002
• Status: Abandoned Application

• Current Assignee: Welch Allyn Incorporated
• Original Assignee: Welch Allyn Incorporated
• Inventors: Newman, Richard W., Danna, Dominick
• Application Number:
  US10/094,121
• Publication Number:
  US 20030171655A1
• Time in Patent Office: Days
• US Class Current: 600/200
• CPC Class Codes: A61B 1/227 for ears, i.e. otoscopes
• CPC Class Codes: A61B 5/0059 using light, e.g. diagnosis by transillumination, diascopy, fluorescence A61B5/0093, A61B5/1455, A61B5/02416 and A61B5/0261 take precedence
• CPC Class Codes: A61B 5/01 Measuring temperature of body parts ; Diagnostic temperature sensing, e.g. for malignant or inflamed tissue clinical contact thermometers G01K13/20
• CPC Class Codes: A61B 5/121 evaluating hearing capacity
• CPC Class Codes: A61B 5/6817 Ear canal
• CPC Class Codes: A61B 7/003 Detecting lung or respiration noise
• CPC Class Codes: Y02A 90/10 Information and communication technologies [ICT] supporting adaptation to climate change, e.g. for weather forecasting or climate simulation

Abstract

An otoscopic instrument permits visual inspection of the ear canal and includes at least one chemical sensing element for detecting a fluid indicative of a disease as well as at least one of an infrared thermometer, and a mechanism for determining pressure variations and the presence of fluid in the ear for providing a comprehensive examination of a patient. The instrument can also be adapted for use with other body cavities such as the throat and nose, among others.

Claims

1. A medical diagnostic instrument comprising:

at least one chemical sensor for determining the presence of a fluid indicative of a disease; and

viewing means for viewing a medical target of interest.

2. An instrument as recited in claim 1, including an insertion portion capable of being inserted to a predetermined distance into the ear canal of a patient, wherein said at least one chemical sensor is disposed within said insertion portion.

3. An instrument as recited in claim 1, wherein said viewing means includes an eyepiece aligned with an insertion portion along an optical axis.

4. An instrument as recited in claim 1, wherein said viewing means includes a image sensor.

5. An instrument as recited in claim 4, wherein said image sensor is disposed in said insertion portion of said instrument.

6. An instrument as recited in claim 1, including temperature measuring means for determining the body temperature of a patient.

7. An instrument as recited in claim 6, wherein said temperature measuring means includes at least one IR sensor capable of providing a thermal image of the medical target.

8. An instrument as recited in claim 6, wherein said temperature measuring means includes means for determining the pulse rate of the patient.

9. An instrument as recited in claim 1, including fluid detecting means for detecting the presence of fluid in the middle ear.

10. An instrument as recited in claim 1, including pressure measuring means for measuring pressure variations in the middle ear.

11. An instrument as recited in claim 10, wherein said pressure measuring means includes at least one of at least one of pneumatic otoscopy, oto-reflectance, impedance reflectance, and tympanometry means for determining pressure variations in the middle ear.

12. An instrument as recited in claim 9, wherein said fluid detecting means includes at least one of pneumatic otoscopy, oto-reflectance, acoustic reflectance, impedance reflectance, and tympanometry means for detecting the presence of fluid in the middle ear.

13. An instrument as recited in claim 1, including a microphone capable of determining the respiration rate of a patient.

14. An instrument as recited in claim 1, including spectroscopic means for determining the presence of pathogens, said spectroscopic means including a light source capable of emitting predetermined wavelengths of light and detecting means capable of detecting predetermined wavelengths of light emitted from the medical target.

15. An instrument as recited in claim 2, including means for determining hearing in the inner ear.

16. An instrument as recited in claim 15, wherein said hearing determining means includes at least one of otoreflectance means and otoacoustic emission means for determining hearing in the inner ear.

17. An instrument as recited in claim 1, wherein said instrument is capable of inserting said at least one chemical sensor into an anatomical body cavity.

18. An instrument as recited in claim 17, wherein said anatomical body cavity is the throat.

19. An instrument as recited in claim 17, wherein said anatomical body cavity is the ear.

20. An instrument as recited in claim 17, wherein said anatomical body cavity is the nose.

149. An instrument as recited in claim 7, wherein said viewing means includes an image sensor, said instrument further including display means for displaying at least one of a thermal image and at least one of a continuous and still video image of said medical target.

150. An instrument as recited in claim 149, including spectroscopic means for determining the presence of pathogens, said spectroscopic means including a light source capable of emitting predetermined wavelengths of light and detecting means capable of detecting predetermined wavelengths of light emitted within the medical target said display means being capable of displaying at least one of a thermal image, a video image, and a spectroscopic image of said medical target.

21. An otological instrument comprising:

oto-reflectance means for determining at least one of detecting a middle-ear disorder and hearing in the inner ear; and

pathogen sensing means for determining the presence of a disease.

22. An instrument as recited in claim 21, including viewing means for viewing the interior of said ear.

23. An instrument as recited in claim 22, including an insertion portion, wherein said viewing means includes an eyepiece aligned with said insertion portion.

24. An instrument as recited in claim 22, wherein said viewing means includes a image sensor.

25. An instrument as recited in claim 24, wherein said image sensor is disposed in an insertion portion of said instrument.

26. An instrument as recited in claim 21, including temperature measuring means for determining the body temperature of the patient.

27. An instrument as recited in claim 26, wherein said temperature measuring means includes at least one IR sensor capable of providing a thermal image of the interior of said ear.

28. An instrument as recited in claim 26, wherein said temperature measuring means includes means for determining the pulse rate of the patient.

29. An instrument as recited in claim 21, including pneumatic otoscopy means for stimulating the tympanic membrane.

30. An instrument as recited in claim 21, including a microphone disposed in an insertion portion, said microphone being capable of determining the respiration rate of a patient.

31. An instrument as recited in claim 21, wherein said pathogen sensing means includes spectroscopic means for detecting the presence of pathogens including a light source capable of emitting predetermined wavelengths of light and detecting means capable of detecting predetermined wavelengths of light at least one of emitted or reflected within the ear.

32. An instrument as recited in claim 21, wherein said pathogen sensing means includes at least one chemical sensor for determining the presence of a fluid indicative of a disease.

151. An instrument as recited in claim 27, including viewing means for viewing the interior of said ear including an image sensor, said instrument further including display means for displaying at least one of a video image and a thermal image of the interior of the ear.

152. An instrument as recited in claim 151, including spectroscopic means for determining the presence of pathogens, said spectroscopic means including a light source capable of emitting predetermined wave lengths of light and detecting means capable of detecting predetermined wave lengths of light emitted within the medical target said display means being capable of displaying at least one of a thermal image, a video image, and a spectroscopic image.

33. A medical diagnostic instrument comprising:

viewing means for viewing a medical target; and

temperature measuring means for measuring body temperature of a patient, said temperature measuring means including at least one sensor capable of producing an output signal which is indicative of temperature and processing electronics for processing output signals from said at least one sensor.

34. An instrument as recited in claim 33, wherein said medical target is an anatomical body cavity.

35. An instrument as recited in claim 34, wherein said body cavity is the throat.

36. An instrument as recited in claim 34, wherein said body cavity is the ear.

37. An instrument as recited in claim 34, wherein said body cavity is the nose.

38. The instrument as recited in claim 36, including means for measuring pressure variations within the middle ear.

39. The instrument as recited in claim 38, wherein said pressure measuring means includes at least one of pneumatic otoscopy, oto reflectance, impedance reflectance, and tympanometry means for determining pressure variations in the middle ear.

40. The instrument as recited in claim 36, including means for determining hearing in the inner ear.

41. The instrument as recited in claim 40, wherein said hearing determining means includes at least one otoreflectance means and otoacoustic emission means for determining hearing in the middle ear.

42. The instrument as recited in claim 33, including an insertion portion and an optical system aligned with said insertion portion including an eyepiece which receives a focused image of a target from said optical system.

43. The instrument as recited in claim 42, wherein said viewing means includes an optical system aligned with said insertion portion and an image sensor, said image sensor and said optical system being aligned along an optical axis.

44. The instrument as recited in claim 43, wherein said image sensor is disposed within insertion portion and aligned with focusing optics for guiding a focused optical image viewed through said insertion portion.

45. The instrument as recited in claim 43, including a display for displaying a video image as captured by said image sensor, said display being provided on an eyepiece portion of said instrument.

46. The instrument as recited in claim 33, including sensing means for detecting the presence of pathogens in the medical target.

47. The instrument as recited in claim 46, wherein said pathogen sensing means includes spectroscopic means including light emitting means for emitting a light having a predetermined wavelength and means for analyzing a spectrum of light which is at least one of reflected and fluoresced from the interior of said medical target.

48. The instrument as recited in claim 46, wherein said pathogen sensing means includes at least one chemical sensor capable of detecting the presence of a disease and emitting an output signal indicative of the relative amount thereof.

49. An instrument as recited in claim 33, wherein said temperature measuring means includes means for determining pulse.

50. An instrument as recited in claim 33, including a microphone capable of determining the respiration rate of a patient.

51. The instrument as recited in claim 36, including means for detecting the presence of fluid in the middle ear.

52. The instrument as recited in claim 51, wherein said fluid detecting means includes at least one of pneumatic otoscopy, acoustic reflectance, oto-reflectance, impedance reflectance, and tympanometry means for detecting the presence of fluid in the middle ear.

153. An instrument as recited in claim 45, wherein said display is capable of displaying at least one of a video image and a thermal image as captured by said temperature measuring means.

154. An instrument as recited in claim 153, including spectroscopic means for determining the presence of pathogens, said spectroscopic means including a light source capable of emitting predetermined wave lengths of light and detecting means capable of detecting predetermined wave lengths of light emitted within the medical target said display means being capable of displaying at least one of a thermal image, a video image, and a spectroscopic image of said medical target.

53. An instrument for determining the condition of an ear, said instrument comprising:

means for viewing the ear interior; and

means for measuring pressure variations within the ear.

54. The instrument as recited in claim 53, including temperature measuring means for measuring body temperature of a patient, said temperature measuring means including at least one infrared sensor capable of producing an output signal which is indicative of temperature.

55. The instrument as recited in claim 54, including processing electronics for processing output signals from said at least one infrared sensor.

56. The instrument as recited in claim 54, wherein said temperature measuring means includes means for determining pulse rate.

57. The instrument as recited in claim 53, wherein said pressure measuring means includes at least one of pneumatic otoscopy, impedance reflectance, oto-reflectance, and tympanometry means for measuring pressure variations in the middle ear.

58. The instrument as recited in claim 53, including means for determining hearing in the inner ear.

59. The instrument as recited in claim 58, wherein said hearing determining means includes at least one of otoreflectance and otoacoustic emission means for determining hearing in the inner ear.

60. The instrument as recited in claim 53, including an insertion portion, said viewing means including an optical system aligned with said insertion portion and an eyepiece which receives a focused image of a target from said optical system.

61. The instrument as recited in claim 60, wherein said viewing means includes an optical system aligned with said insertion portion and an imaging sensor, said imaging sensor and said optical system being aligned along an optical axis.

62. The instrument as recited in claim 61, wherein said imaging sensor is disposed within insertion portion and aligned with focusing optics for guiding a focused optical image viewed through said insertion portion.

63. The instrument as recited in claim 61, including a display for displaying a video image as captured by said imaging sensor, said display being provided on an eyepiece portion of said instrument.

64. The instrument as recited in claim 53, including sensing means for detecting the presence of pathogen in the ear.

65. The instrument as recited in claim 64, wherein said sensing means includes spectroscopic means includes light emitting means for emitting a light having at least one predetermined wavelength and means for analyzing a spectrum of light which is at least one of reflected and fluoresced from the interior of said ear.

66. The instrument as recited in claim 64, wherein said sensing means includes at least one chemical sensor capable of detecting th e presence of a disease and emitting an output signal indicative of the relative amount thereof.

67. The instrument as recited in claim 53, including a microphone insertable in the ear capable of detecting the respiration rate of a patient.

155. An instrument as recited in claim 55, wherein said viewing means includes an image sensor and said instrument further including display means connected to said processing electronics and said image sensor for producing at least one of a video image and a thermal image of the ear interior.

156. An instrument as recited in claim 155, including spectroscopic means for determining the presence of pathogens, said spectroscopic means including a light source capable of emitting predetermined wave lengths of light and detecting means capable of detecting predetermined wave lengths of light emitted within the medical target said display means being capable of displaying at least one of a thermal image, a video image, and a spectroscopic image.

68. A diagnostic instrument comprising:

means for viewing a medical target; and

sensing means for detecting the presence of pathogen at the medical target.

69. The instrument as recited in claim 68, wherein said medical target is an anatomical body cavity.

70. The instrument as recited in claim 69, wherein said body cavity is the throat.

71. The instrument as recited in claim 69, wherein said body cavity is the ear.

72. The instrument as recited in claim 69, wherein said body cavity is the nose.

73. The instrument as recited in claim 68, including temperature measuring means for measuring the body temperature of a patient, said temperature measuring means including at least one infrared sensor capable of producing an output signal which is indicative of temperature.

74. The instrument as recited in claim 73, wherein said pathogen detecting means includes said temperature measuring means.

75. The instrument as recited in claim 73, including processing electronics for processing output signals from said at least one infrared sensor and said sensing means.

76. The instrument as recited in claim 73, wherein said temperature measuring means includes means for determining pulse rate.

77. The instrument as recited in claim 71, including pressure measuring means for measuring pressure variations within the middle ear.

78. The instrument as recited in claim 77, wherein said pressure measuring means includes at least one of pneumatic otoscopy, otoreflectance impedance reflectance and tympanometry means for measuring pressure variations in the middle ear.

79. The instrument as recited in claim 71, including fluid detecting means including at least one of pneumatic otoscopy, acoustic reflectance, impedance reflectance, oto reflectance and tympanometry means for determining pressure variations in the middle ear.

80. The instrument as recited in claim 71, including means for determining hearing in the inner ear.

81. The instrument as recited in claim 80, wherein said hearing determining means includes at least one of otoreflectance and otoacoustic emission means for determining hearing in the inner ear.

82. The instrument as recited in claim 68, including an insertion portion, said viewing means including an optical system aligned with said insertion portion and an eyepiece which receives a focused image of a target from said optical system.

83. The instrument as recited in claim 82, wherein said viewing means includes an optical system aligned with said insertion portion and an imaging sensor, said imaging sensor and said optical system being aligned along an optical axis.

84. The instrument as recited in claim 83, wherein said imaging sensor is disposed within insertion portion and aligned with focusing optics for guiding a focused optical image viewed through said insertion portion.

85. The instrument as recited in claim 83, including a display for displaying a video image as captured by said imaging sensor, said display being provided on an eyepiece portion of said instrument.

86. The instrument as recited in claim 68, wherein said pathogen sensing means includes spectroscopic means includes light emitting means for emitting a light having at least one predetermined wavelength and means for analyzing a spectrum of light which is at least one of reflected and fluoresced from the interior of said medical target.

87. The instrument as recited in claim 68, wherein said pathogen sensing means includes at least one chemical sensor capable of detecting the presence of a disease and emitting an output signal indicative thereof.

88. An instrument as recited in claim 68, including a microphone positionable in relation to the medical target to determine the respiration rate of a patient.

157. An instrument as recited in claim 75, including viewing means for viewing the ear interior including an image sensor, said instrument further including display means connected to said processing electronics and said image sensor for producing at least one of a video image and a thermal image of the ear interior.

158. An instrument as recited in claim 157, including spectroscopic means for determining the presence of pathogens, said spectroscopic means including a light source capable of emitting predetermined wave lengths of light and detecting means capable of detecting predetermined wave lengths of light emitted within the medical target said display means being capable of displaying at least one of a thermal image, a video image, and a spectroscopic image.

89. An instrument for determining conditions of the ear, said instrument comprising:

temperature measuring means for determining the body temperature of a patient, said temperature measuring means including at least one miniature infrared sensor capable of providing a thermal image of the interior of the ear; and

pressure measuring means for measuring pressure variations within the middle ear.

90. The instrument as recited in claim 89, wherein said pressure measuring means includes at least one of pneumatic otoscopy, otoreflectance, impedance reflectance, and tympanometry means for measuring pressure variations in the middle ear.

91. The instrument as recited in claim 89, wherein said temperature measuring means includes means of measuring the pulse based on transient changes in the thermal image produced by said infrared sensor array.

92. The instrument as recited in claim 89, including a microphone arranged so as to measure the respiratory rate of said patient.

93. The instrument as recited in claim 89, including means for determining hearing, said hearing determining means including at least one of otoreflectance and otoacoustic emission means for determining hearing in the inner ear.

94. The instrument as recited in claim 89, including fluid detecting means including at least one of pneumatic otoscopy, acoustic reflectance, impedance reflectance, oto reflectance, and tympanometry means for detecting fluid in the middle ear.

95. The instrument as recited in claim 89, including sensing means for sensing the presence of bacteria and viruses indicative of otitis.

96. The instrument as recited in claim 95, wherein said sensing means includes spectroscopic means including light emitting means for emitting a light having at least one predetermined wavelength and means for analyzing a spectrum of light which is at least one of reflected and fluoresced from the interior of said ear.

97. The instrument as recited in claim 95, wherein said sensing means includes at least one chemical sensor capable of detecting the presence of a disease and emitting an output signal indicative thereof.

98. The instrument as recited in claim 89, including viewing means for viewing the interior of the ear, said temperature measuring means and said pressure measuring means being disposed in relation to said viewing means so as not to interfere therewith.

99. The instrument as recited in claim 98, wherein said viewing means includes an image sensor.

100. The instrument as recited in claim 99, wherein said image sensor is disposed in an insertion portion of said instrument.

101. The instrument as recited in claim 99, wherein said viewing means includes an eyepiece aligned with an insertion portion.

159. An instrument as recited in claim 99, including display means connected to said image sensor and said temperature measuring means for displaying at least one of a video image and a thermal image of the ear.

160. An instrument as recited in claim 159, including spectroscopic means for determining the presence of pathogens, said spectroscopic means including a light source capable of emitting predetermined wave lengths of light and detecting means capable of detecting predetermined wave lengths of light emitted within the medical target said display means being capable of displaying at least one of a thermal image, a video image, and a spectroscopic image.

102. A medical diagnostic instrument comprising:

temperature measuring means for determining the body temperature of a patient, said temperature measuring means including an array of infrared sensors capable of providing a thermal image of a medical target; and

sensing means for sensing the presence of pathogens indicative of an anomalous medical condition.

103. The instrument as recited in claim 102, wherein said medical target is an anatomical body cavity.

104. The instrument as recited in claim 103, wherein said body cavity is the throat.

105. The instrument as recited in claim 103, wherein said body cavity is the ear.

106. The instrument as recited in claim 103, wherein said body cavity is the nose.

107. The instrument as recited in claim 102, wherein said pathogen sensing means includes spectroscopic means including light emitting means for emitting a light having a predetermined wavelength and means for analyzing a spectrum of light which is at least one of reflected and fluoresced from the interior of said medical target.

108. The instrument as recited in claim 102, wherein said pathogen sensing means includes at least one chemical sensor capable of detecting the presence of a disease and emitting an output signal indicative thereof.

109. The instrument as recited in claim 105, including pressure measuring means for measuring pressure variations in the ear.

110. The instrument as recited in claim 109, wherein said pressure measuring means includes at least one of pneumatic otoscopy, otoreflectance, impedance reflectance, and tympanometry means for measuring pressure variations in the middle ear.

111. The instrument as recited in claim 105, including means for determining hearing in the inner ear.

112. The instrument as recited in claim 102, wherein said temperature measuring means includes means of measuring pulse rate based on transient changes in the thermal image produced by said infrared sensor array.

113. The instrument as recited in claim 102, including a microphone arranged so as to measure the respiratory rate of said patient.

114. The instrument as recited in claim 102, including viewing means for viewing said medical target, said temperature measuring means and said sensing means being disposed in relation to said viewing means so as not to interfere therewith.

115. The instrument as recited in claim 114, wherein said viewing means includes an image sensor.

116. The instrument as recited in claim 115, wherein said image sensor is disposed in an insertion portion of said instrument.

117. The instrument as recited in claim 114, wherein said viewing means includes an eyepiece aligned with an insertion portion.

118. The instrument as recited in claim 105, including means for detecting fluid in the middle ear.

119. The instrument as recited in claim 118, wherein said fluid detecting means includes at least one of pneumatic otoscopy, acoustic reflectance, otoreflectance, impedance reflectance, and tympanometry means for detecting fluid in the middle ear.

161. An instrument as recited in claim 116, including display means connected to said image sensor and said temperature measuring means for displaying at least one of a video image and a thermal image of the ear.

162. An instrument as recited in claim 161, including spectroscopic means for determining the presence of pathogens, said spectroscopic means including a light source capable of emitting predetermined wave lengths of light and detecting means capable of detecting predetermined wave lengths of light emitted within the medical target said display means being capable of displaying at least one of a thermal image, a video image, and a spectroscopic image.

120. A medical instrument system capable of comprehensively examining the ear, said system comprising:

a housing having an insertion portion sized for fitting a predetermined distance within the ear canal of a patient;

means for examining the outer ear;

means for examining the middle ear; and

means for examining the inner ear of a patient, each of said examining means being at least partially contained within said housing.

121. The system as recited in claim 120, including means for determining certain vital signs of the patient.

122. The system as recited in claim 121, wherein said vital signs determining means includes temperature measuring means for determining the body temperature of a patient.

123. The system as recited in claim 122, wherein said temperature measuring means includes an array of sensors capable of providing a thermal image of the ear interior including the tympanic membrane and processing electronics for processing output signals produced by said array.

124. The system as recited in claim 123, wherein the processing electronics of said temperature measuring means includes means for determining transient changes in the thermal image produced by said array so as to determine pulse rate.

125. The system as recited in claim 121, wherein said vital signs determining means includes a microphone for detecting inspiration and expiration sounds of a patient and processing means for distinguishing between inspiration and respiratory sounds in order to determine respiratory rate thereof.

126. The system as recited in claim 120, wherein at least one of said inner ear, said outer ear and said middle ear examining means includes sensing means for sensing the presence of bacteria and viral conditions.

127. The system as recited in claim 126, wherein said bacteria and viral condition sensing means includes spectroscopic means having light emitting means for emitting a light having at least one predetermined wavelength and means for analyzing a spectrum of light which is at least one of reflected and fluoresced from the interior of said ear.

128. The system as recited in claim 126, wherein said sensing means includes at least one chemical sensor capable of emitting an output signal indicative of the presence of a disease and processing means for processing said signal.

129. The system as recited in claim 128, wherein said at least one chemical sensor is disposed within an insertion portion of said instrument.

130. The system as recited in claim 128, wherein said at least one chemical sensor is disposed within a handle portion of said instrument.

163. A system as recited in claim 123, including viewing means including an image sensor for viewing the ear interior, and display means for displaying at least one of a video image and a thermal image of the ear.

164. A system as recited in claim 163, including spectroscopic means for determining the presence of pathogens, said spectroscopic means including a light source capable of emitting predetermined wave lengths of light and detecting means capable of detecting predetermined wave lengths of light emitted within the medical target said display means being capable of displaying at least one of a thermal image, a video image, and a spectroscopic image.

131. An otological instrument comprising:

pressure determining means for determining pressure variations in the middle ear; and

means for sensing the presence of pathogens in the ear.

132. The instrument as recited in claim 131, including viewing means for viewing the interior of the ear.

133. The instrument as recited in claim 131, including an insertion portion for inserting a predetermined distance into the ear canal.

134. The instrument as recited in claim 132, wherein said viewing means includes an image sensor.

135. The instrument as recited in claim 133, including an eyepiece attached to said insertion portion.

136. The instrument as recited in claim 131, wherein said pathogen sensing means includes spectroscopic means including light emitting means for emitting a light having at least one predetermined wavelength and means for analyzing a spectrum of light which is at least one of reflected and fluoresced from the interior of an ear.

137. The instrument as recited in claim 131, wherein said pathogen sensing means includes at least one chemical sensor capable of detecting the presence of a disease and emitting an output signal indicative thereof.

138. The instrument as recited in claim 131, including means for determining hearing in the inner ear.

139. The instrument as recited in claim 138, wherein said hearing determining means includes at least one of oto-reflectance means and otoacoustic emission means for determining hearing in the inner ear.

140. The instrument as recited in claim 131, wherein said pressure determining means includes at least one of pneumatic otoscopy, impedance reflectance, otoreflectance and tympanometry means for determining pressure variations in the middle ear.

141. The instrument as recited in claim 131, including fluid detecting means for detecting the presence of fluid in the middle ear.

142. The instrument as recited in claim 131, wherein said fluid detecting means includes at least one of pneumatic otoscopy, acoustic reflectance, oto-reflectance, impedance reflectance, and tympanometry means for detecting the presence of fluid in the middle ear.

143. The instrument as recited in claim 131, including temperature measuring means for determining the body temperature of a patient.

144. The instrument as recited in claim 143, wherein said temperature measuring means includes an array of sensors capable of providing a thermal image of the tympanic membrane.

145. The instrument as recited in claim 143, wherein said temperature measuring means includes means for determining the pulse rate of a patient.

146. The instrument as recited in claim 131, including a microphone capable of determining the respiration rate of a patient.

166. An instrument as recited in claim 144, including viewing means for viewing the interior of the ear, said viewing means including at least one image sensor and a display, said display being connected to said image sensor and said temperature measuring means for displaying at least one of a video image and a thermal image.

147. A method for examining a medical target using a combination otoscope, said method comprising the steps of:

disposing at least one chemical sensing element in an otoscope, said at least one chemical sensing element being capable of detecting at least one fluid indicative of a disease;

performing an otological examination of an ear of patient;

placing said at least one chemical sensing element into the ear; and

indicating when said at least one fluid is detected.

148. A method as recited in claim 147, including the steps of:

placing said at least one chemical sensing element into another body cavity of said patient; and

indicating when at least one fluid is detected.

165. A method as recited in claim 148, wherein said combination otoscope includes video imaging means for producing a video image of said ear and body cavity and thermal imaging means for producing a thermal image thereof, said method including the additional step of displaying at least one of a thermal image and a video image.