PANCE Blueprint EENT (7%)

External ear (PEARLS)

NCCPA™ PANCE EENT Content Blueprint ear disorders ⇒ external ear

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)

External Ear Trauma Trauma to the external ear may result in hematoma, laceration, avulsion, or fracture

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


  • 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”
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


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
Brian Wallace PA-C Podcast: Disorders of the Ear Part One and Two (Prev Lesson)
(Next Lesson) Cerumen impaction
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