HEAD, EYE, EAR, NOSE, AND THROATEMERGENCIESTREATMENT
■ Keep ear dry.
■ Analgesics
■ Follow-up ENT
■ Antibiotics if contaminated or infected (diving and rupture in seawater)
■ Most heal in a few months (90%).
COMPLICATIONS
■ Facial nerve palsy
■ Vertigo
■ Hearing loss
Hearing Loss
There are two types of hearing loss: sensorineural or conductive.
SYMPTOMS/EXAM
■ Rinne test: A 512-Hz tuning fork is placed on the mastoid then placed
next to external auditory canal. Normally, air conduction is better than
bone. If the patient hears the sound better when the fork is placed on the
mastoid, this indicates a conductive hearingloss in this ear.
■ Weber test: The tuning fork is placed on the center of the forehead. The
sound should be equal in both ears. If unequal, the side where the sound
is heard better is the source of a conductive hearing problem. The side
where the sound is heard less is the source of a sensorineural hearing prob-
lem (see Figure 14.5).
MENIEREDISEASE
Increased volume of endolymph causing unilateral sensorineural hearing loss,
vertigo, tinnitus
FIGURE 14.4. Tympanic membrane perforation.
(Courtesy of Richard A. Chole, MD, PhD as published in Knoop KJ, Stack LB, Storrow AB.
Atlas of Emergency Medicine,2nd ed. New York: McGraw-Hill, 2002:124.)
FIGURE 14.5. Weber
test.(Reproduced, with permis-
sion, from Stone CK,
Humphries, RL. Current
Emergency Diagnosis and
Treatment, 5th ed. New
York: McGraw-Hill,
2004:629.)