Golden rules referring to adults
- unilateral acute otitis externa is a serious pseudomonas infection until proved otherwise *
- unilateral glue ear in an adult is a post nasal space tumour until proved otherwise
- otitis externa in diabetes needs to be treated in an ENT department. It may be necrotising otitis externa
- superior or postero superior disease in chronic secretory otitis media is cholesteatoma
- sudden sensory neurological hearing loss is an otological emergency and should be referred to the ENT department
- remember the false negative Rhinne test. Always use the Weber as well
- all cases of unilateral sensorineural hearing loss need to have acoustic neuromas excluded
- sudden hearing loss, tinnitus or vertigo - think about perilymph leak
- patients with only one hearing ear - send to the ENT department
* more than 90% of cases of otitis externa are due to bacteria - most commonly Pseudomonas aeruginosa (22–62%) and Staphylococcus aureus (11–34%) (1)
Reference:
- Roland PS, Stroman DW. Microbiology of acute otitis externa. Laryngoscope. 2002;112:1166–1177
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