External ear (PEARLS)
| Cerumen Impaction |
Cerumen impaction—buildup obstructs the auditory canal and is the most common cause of conductive hearing loss
- Abnormal Rinne test—bone conduction is better than air conduction
- Weber—sound lateralizes to the affected side (tuning fork is perceived more loudly in the ear with a conductive hearing loss)
TX: Irrigation after several days of softening with carbamide peroxide (Debrox) or triethanolamine (Cerumenex) |
| Otitis externa |
Edema with cheesy white discharge, palpation of the tragus is painful
- Pseudomonas aeruginosa (swimmer’s ear)
- S. aureus (digital trauma)
- Malignant otitis externa is commonly seen in diabetics
TX:
Bacterial otitis externa:
- If perforated or chance of perforation: Ciprofloxacin 0.3% and dexamethasone 0.1% suspension: 4 drops BID × 7 days or ofloxacin: 0.3% solution 10 drops once a day × 7 days
- Cortisporin otic drops
Fungal otitis externa
- Topical therapy, anti-yeast for Candida or yeast: 2% acetic acid 3–4 drops QID; clotrimazole 1% solution; itraconazole oral
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Back to PANCE Blueprint EENT (7%)
