Inspect the ear drum for color and contour. In acute otitis media, the eardrum is red and bulging. From one or both sides. A bilateral watery discharge associated with sneezing and nasal congestion indicate an allergy. One sided purulent, thick greenish and extremely malodorous discharge may indicate a foreign body.
Nasal septum noting any deviation, inflammation or perforation.
Avoid pressure on the eyes. Then press up on each maxillary sinus by pressing under the zygomatic processes. Next percuss the sinus areas to detect tenderness. Lightly tap directly of each sinus area with your finger. Another method is to transilluminate the sinuses in a dark room.