For example, the screening staff may not have the skills in otoscopy, or ear examination, to identify ear pathology as such, other than through gross visual examination for disorders such as pinna abnormalities, discharge, or impacted wax ( McPherson & Olusanya, 2008 ) . advises against the use of tympanometry in screening for developing countries where the prevalence of otitis media is high since " ( a ) ear discharge can be better noted through visual inspection of the ear, and ( b ) identification of moderate to severe hearing loss is a priority " ( McPherson & Olusanya, 2008 ).
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