PANCE Blueprint EENT (7%)

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


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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