FACTS & HINTS
High-Yield Facts
Clinical Points
Otitis externa
Defined as an inflammation or infection of the external ear
Also called swimmer's ear
Usually bacterial in origin
Pathogens include pseudomonas aeruginosa and staphylococcus aureus
Patient may present with itchiness, a sensation of having the ear blocked, and pain
Ear on examination is painful, erythematous, and may be discharging pus
Treatment is with topical antibiotics (eardrops)Clinical Points
Otitis media
Defined as an inflammation of the middle ear
Also known as glue ear
Most common in children between the ages of 6 months and 2 years
Symptoms include: pulling or rubbing the ears because of ear pain, fever, fussiness, or irritability, fluid leaking from the ear, changes in
appetite or sleeping patterns, trouble hearing
Usually to the result of bacterial infection
On examination with an otoscope, the ear drum looks dull with loss of the cone of light
Commonly treated with antibiotics
With frequent reoccurring infections and evidence of hearing loss or speech delay, small tubes called tympanostomy tubes are placed in the
eardrums to ventilate the area behind the eardrum and keep the pressure equalized to atmospheric pressure in the middle ear.Clinical Points
Weber Test and Rinne Test for Hearing
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Weber Test
With a Weber test of hearing, a tuning fork is struck and placed on the patient's forehead
The patient is asked to report in which ear the sound is heard louder
This test cannot confirm normal hearing, because hearing defects affecting both ears equally will produce an apparently normal test result
A Rinne test should be done at the same timeRinne Test
A Rinne test compares perception of sounds, as transmitted by air or by sound conduction through the mastoid
This is achieved by placing a vibrating tuning fork (512 Hz) initially on the mastoid, then next to the ear and asking which sound is loudest
A patient with normal hearing with a positive Rinne on both sides would hear the sound equally in both ears or may not even hear it at all if
the room is noisy enough to mask the subtle sound of the tuning fork
A patient with a unilateral (one-sided) conductive hearing loss would hear the tuning fork loudest in the affected ear (conduction through
bone is more effective that the normal route through the outer and middle ear)