PANCE Blueprint EENT (7%)

• 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)

Subperichondrial hematoma (cauliflower ear)

• Blunt trauma to the pinna may cause a subperichondrial hematoma and accumulation of large amounts of blood between the perichondrium and cartilage
• This can interrupt the blood supply to the cartilage and render all or part of the pinna a shapeless, reddish purple mass
• Avascular necrosis of the cartilage may follow
• The resultant destruction causes the characteristic cauliflower ear of wrestlers and boxers

TX:

• The most appropriate course of action for this patient is to refer immediately for I & D by an ENT specialist for the best results
• The cartilage of the pinna requires vascular supply from the perichondrium. If deprived of blood, the devascularized tissue can become permanently damaged resulting in the so-called “cauliflower ear”

• 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