Otoscopy
Show a learner an otoscope view of the ear canal and tympanic membrane, then have them identify the finding.
The Otoscopy element simulates looking into the ear with an otoscope. You choose a real otoscopy image for the right ear, the left ear, or both, and the learner inspects what they see, just as they would peering down a patient's ear canal at the eardrum. During a submission the learner sweeps a spotlight across the image to examine it, then records their finding — the category (for example Within normal limits, Cerumen, or Perforation), whether a referral is needed, and an optional written interpretation.
Like every Theta element, otoscopy follows the same four phases: Design → Testing → Scoring → Report.
Design
You configure the right and left ears independently, side by side. Each ear is its own panel — the right ear is labelled in red, the left in blue — and you can enable one or both.
Enabling an ear
Each ear panel starts with an Enable button. Click it to add that ear to the case; a configured ear shows a Remove button instead, which clears it back out. A case needs at least one ear enabled to show anything to the learner.
When you first add an otoscopy element, Theta automatically loads a default Within normal limits image into each enabled ear so the case renders something sensible right away. You should still open the element and review it — the designer will remind you on save or test if an otoscopy was never reviewed, so you can either go back and pick the image you want or proceed deliberately.
Choosing the image
Inside an enabled ear, the Image control opens an image picker:
- Pick a category from the dropdown (the categories come from the otoscopy image library — only categories that have images are listed).
- The picker shows a thumbnail grid of every image in that category for that ear.
- Click a thumbnail to select it. The picker closes and a circular preview of the chosen image appears in the ear panel.
Selecting an image does two helpful things automatically:
- It sets the ear's finding to match the category you browsed (so picking from the Perforation category sets the finding to Perforation, and the Within normal limits category sets it to normal).
- It seeds the report feedback with the image's clinical description, if the image has one. This becomes the model answer shown on the report — you can edit or replace it.
To swap the image later, open the picker again; the button reads Change image once an image is set.
The image you select is the same image the learner sees in the submission and the same image that prints on the report. There is no separate "learner image" — one picture flows through the whole lifecycle.
The expected finding (category)
Below the image you set the ear's finding — the correct diagnosis for this ear. The finding dropdown offers the full otoscopy vocabulary:
| Finding | Finding |
|---|---|
| Within normal limits | Otitis Externa |
| Cerumen (Partially occluding) | Otitis Media (Acute) |
| Cerumen (Completely occluding) | Otitis Media (Effusion) |
| Cholesteatoma | Otosclerosis |
| Exostosis | Perforation |
| Foreign Body | Retraction |
| Fungus | Tympanostomy/PE tube |
| Glomus Tumor | Tympanosclerosis |
| Other | Tympanoplasty |
Choosing a non-normal finding marks the ear as abnormal; Within normal limits marks it normal. This finding is the value the learner's answer is compared against when category scoring is on.
Referral
Each ear has a Referral needed checkbox. Tick it when the correct clinical decision is to refer the patient on (for example, an unexplained abnormality). This becomes the expected answer when referral scoring is enabled for that ear.
Template vs. fixed
Otoscopy supports both modes, using the same lock / shuffle toggle on the element card as every other element.
- Fixed (the padlock, the default) — every learner sees exactly the image you picked.
- Template (the shuffle icon) — the expected finding stays exactly as you set it, but each submission draws a different image from that same category for that ear. A case authored as Perforation stays a perforation case; the learner just doesn't see the same perforation as the person next to them.
Template mode is what makes an otoscopy case worth reusing: the answer can't be memorised from a screenshot, because the picture changes. It falls back to your chosen image when the library has no other image in that category for that ear, so a thinly-stocked category degrades to fixed behaviour rather than breaking.
When the image re-rolls, your instructor feedback re-rolls with it if you left the auto-seeded image description in place — otherwise the feedback would describe a picture the learner never saw. Feedback you wrote or edited yourself is always kept exactly as you typed it.
Settings
Otoscopy keeps the design itself simple; the configurable options live in the ear panels and in scoring.
| Option | Where | What it does |
|---|---|---|
| Enable / Remove ear | Ear panel header | Adds or clears the right or left ear. |
| Image | Ear panel | Picks the otoscopy picture from the library, filtered by category and ear. |
| Description | Ear panel | Static prompt text shown to the learner alongside the image (context, instructions, or a clinical history snippet). Optional. |
| Let the learner enter their own interpretation | Ear panel | When on, the submission shows a free-text box where the learner writes what they see. The interpretation is recorded and printed on the report but is not auto-scored. On by default. |
| Instructor feedback | Ear panel | A model answer / feedback note shown on the report only — it is hidden from the learner during the submission. Seeded from the image description when you pick an image. |
| Referral needed | Ear panel | The expected referral decision for the ear. |
| Finding | Ear panel | The expected category/diagnosis for the ear. |
The Description field is the learner-facing prompt; the Instructor feedback field is the report-only model answer. Keep anything you don't want the learner to see (the answer, teaching notes) in feedback, not description.
Testing
During a submission the learner sees the configured ears side by side (or a single ear if you only enabled one). Each ear shows a dark circular viewport with the static description prompt beneath it, then the answer controls.
Inspecting the image with the spotlight
By default the image is hidden behind a black mask — the learner reveals it by pressing and dragging a circular spotlight across the viewport, mimicking the narrow beam of an otoscope. The image is only visible inside the spotlight while the pointer is held down; releasing hides it again. This forces deliberate examination rather than a glance at the whole picture.
The spotlight works with both mouse and touch, so it behaves the same on a phone, tablet, or desktop. Theta quietly records how long the learner spends examining each ear as part of the submission action trail.
Reveal full image
A small settings menu (the gear icon in the top corner) offers a Show full image toggle. Turning it on drops the spotlight and shows the whole image at once — useful for review or lower-stakes practice.
In exam mode the settings menu is hidden and the full-image reveal is forced off — learners must always use the spotlight, even if the toggle was somehow set.
Recording the finding
Beneath the image the learner fills in the answer controls. Which controls appear is driven by your scoring choices for that ear:
- Finding — a dropdown of the same categories you chose from. Appears when category scoring (or report-only) is enabled for the ear.
- Referral needed — a Yes / No dropdown. Appears when referral scoring (or report-only) is enabled for the ear.
- Interpretation — a free-text box for the learner's own description. Appears when you left Let the learner enter their own interpretation on.
Answers save automatically as the learner works. If an ear has no scored or report-only fields and interpretation is turned off, the learner simply inspects the image with nothing to record.
Scoring
Open the element's Scoring panel to decide what counts. Each ear has two scorable fields, and each can be set to one of three states (see Scoring for the shared model):
| Field | What's compared |
|---|---|
| Category | The learner's selected finding vs. your expected finding for that ear. |
| Referral needed | The learner's Yes/No referral decision vs. your expected referral. |
For each field you pick:
- Off — not shown, not scored.
- Scored — shown in the submission and counted in the score.
- Report-only — shown in the submission and on the report, but not counted toward the score.
A Sync ears checkbox (on by default) mirrors your choices across both ears so you don't have to set the right and left identically by hand; turn it off to score the ears differently.
The learner's written interpretation is never auto-scored — it is always recorded for the instructor to read on the report.
Report
Each ear that was part of the case prints its own block in the PDF report. Only the ears you enabled appear — a right-ear-only case prints one block, not an empty left-hand column. Each block contains:
- The image the learner saw — the instructor-selected otoscopy picture for that ear (the full image, not the spotlighted view). On a template case this is the image that submission actually drew.
- Prompt — the static description text you showed the learner, if any.
- Category — the finding the learner selected (or Not selected). Printed only when the field was scored or report-only, since an Off field was never put to the learner.
- Referral Needed — the learner's Yes / No decision, on the same rule.
- Interpretation — the learner's free-text description, when they entered one.
- Feedback — your instructor feedback / model answer for the ear, when set.
Below the blocks, a scoring table lists every scored and report-only field with your expected answer, the learner's answer, and whether it matched.
This gives the reviewer the full picture: the image under test, what the learner concluded, and your reference answer side by side. Scored fields contribute to the element's score; report-only fields appear here for context without affecting it.