High-Yield Clinical Ear Conditions Study
Guide
Part 1: Disorders of the External Ear
Cerumen Impaction
● Description: Obstruction of the EAC by accumulated earwax.
● Epidemiology: Affects 10% of children, 5% of healthy adults, and 57% of nursing home
residents.
● Etiology: Overproduction, narrow canal, or mechanical obstruction (Q-tips, hearing
aids).
● Pathophysiology: Cerumen trapped in the lateral 1/3 of the canal blocks sound waves
from hitting the TM.
● Clinical Presentation: Conductive hearing loss, ear fullness, itching, or reflex cough
(Arnold’s nerve).
● Diagnostic Findings: Otoscopy shows yellowish/brown mass obscuring the TM.
● Treatment:
○ Cerumenolytics: Carbamide peroxide 6.5% (Debrox) or Mineral Oil.
○ Irrigation: Warm water with Hydrogen Peroxide (1:1 ratio).
○ Manual Removal: Curettes or suction.
● Buzzwords & Hallmarks: "Arnold's Nerve Reflex" (coughing during ear cleaning),
Conductive Hearing Loss.
Foreign Bodies
● Description: Objects lodged in the EAC.
● Epidemiology: Primarily children <6 years old.
● Etiology: Beads, toys, insects, or button batteries.
● Clinical Presentation: Pain, purulent/foul discharge (otorrhoea), or asymptomatic.
● Diagnostic Findings: Object visible on otoscopy.
● Treatment:
○ Insects: Kill with 2% Lidocaine or Mineral Oil before removal.
○ Batteries: Immediate surgical removal; NO DROPS (risk of liquefaction
necrosis).
● Buzzwords & Hallmarks: "Foul-smelling unilateral discharge" in a child.
, Otitis Externa ("Swimmer's Ear")
● Description: Inflammation/infection of the EAC skin.
● Epidemiology: Peak in summer; common in swimmers and diabetics.
● Etiology: Pseudomonas aeruginosa (#1), S. aureus.
● Pathophysiology: Moisture/trauma breaks down the acid mantle (pH 3.0-5.0), allowing
bacterial overgrowth.
● Clinical Presentation: Severe pain with pulling of the pinna or tragus, itching,
cheesy/purulent discharge.
● Diagnostic Findings: Edematous, red canal; TM may be obscured.
● Treatment:
○ Antibiotic Drops: Ciprofloxacin 0.3%/Dexamethasone 0.1% (Ciprodex) or
Ofloxacin.
○ Combo: Neomycin/Polymyxin B/Hydrocortisone (Cortisporin).
○ Acidification: Acetic acid 2% (Vosol).
● Buzzwords & Hallmarks: "Tragal tenderness," "Pain with auricle tug," "Pseudomonas."
Part 2: Disorders of the Middle Ear
Eustachian Tube Dysfunction (ETD)
● Description: Failure of the tube to regulate middle ear pressure.
● Etiology: URI, allergies, or chronic tobacco use.
● Pathophysiology: Negative pressure develops, pulling the TM inward (retraction).
● Clinical Presentation: "Popping" or "Clicking," ear fullness, fluctuating hearing loss.
● Diagnostic Findings: Retracted TM; restricted mobility on pneumatic otoscopy.
● Treatment:
○ Systemic Decongestants: Pseudoephedrine (Sudafed).
○ Nasal Decongestants: Oxymetazoline (Afrin) (limit to 3 days).
○ Intranasal Steroids: Fluticasone (Flonase).
● Buzzwords & Hallmarks: "Aural fullness," "Symptoms improve with swallowing or
yawning."
Acute Otitis Media (AOM)
● Description: Bacterial infection of the middle ear space.
● Epidemiology: Peak age 6-24 months.
● Etiology: S. pneumoniae, H. influenzae, M. catarrhalis.
● Pathophysiology: ETD leads to fluid stasis; bacteria migrate from the nasopharynx.
● Clinical Presentation: Otalgia, fever, bulging TM, decreased hearing.
● Diagnostic Findings: Bulging, opaque, immobile TM.
● Treatment:
○ First Line: Amoxicillin (High dose: 80-90 mg/kg/day).
Guide
Part 1: Disorders of the External Ear
Cerumen Impaction
● Description: Obstruction of the EAC by accumulated earwax.
● Epidemiology: Affects 10% of children, 5% of healthy adults, and 57% of nursing home
residents.
● Etiology: Overproduction, narrow canal, or mechanical obstruction (Q-tips, hearing
aids).
● Pathophysiology: Cerumen trapped in the lateral 1/3 of the canal blocks sound waves
from hitting the TM.
● Clinical Presentation: Conductive hearing loss, ear fullness, itching, or reflex cough
(Arnold’s nerve).
● Diagnostic Findings: Otoscopy shows yellowish/brown mass obscuring the TM.
● Treatment:
○ Cerumenolytics: Carbamide peroxide 6.5% (Debrox) or Mineral Oil.
○ Irrigation: Warm water with Hydrogen Peroxide (1:1 ratio).
○ Manual Removal: Curettes or suction.
● Buzzwords & Hallmarks: "Arnold's Nerve Reflex" (coughing during ear cleaning),
Conductive Hearing Loss.
Foreign Bodies
● Description: Objects lodged in the EAC.
● Epidemiology: Primarily children <6 years old.
● Etiology: Beads, toys, insects, or button batteries.
● Clinical Presentation: Pain, purulent/foul discharge (otorrhoea), or asymptomatic.
● Diagnostic Findings: Object visible on otoscopy.
● Treatment:
○ Insects: Kill with 2% Lidocaine or Mineral Oil before removal.
○ Batteries: Immediate surgical removal; NO DROPS (risk of liquefaction
necrosis).
● Buzzwords & Hallmarks: "Foul-smelling unilateral discharge" in a child.
, Otitis Externa ("Swimmer's Ear")
● Description: Inflammation/infection of the EAC skin.
● Epidemiology: Peak in summer; common in swimmers and diabetics.
● Etiology: Pseudomonas aeruginosa (#1), S. aureus.
● Pathophysiology: Moisture/trauma breaks down the acid mantle (pH 3.0-5.0), allowing
bacterial overgrowth.
● Clinical Presentation: Severe pain with pulling of the pinna or tragus, itching,
cheesy/purulent discharge.
● Diagnostic Findings: Edematous, red canal; TM may be obscured.
● Treatment:
○ Antibiotic Drops: Ciprofloxacin 0.3%/Dexamethasone 0.1% (Ciprodex) or
Ofloxacin.
○ Combo: Neomycin/Polymyxin B/Hydrocortisone (Cortisporin).
○ Acidification: Acetic acid 2% (Vosol).
● Buzzwords & Hallmarks: "Tragal tenderness," "Pain with auricle tug," "Pseudomonas."
Part 2: Disorders of the Middle Ear
Eustachian Tube Dysfunction (ETD)
● Description: Failure of the tube to regulate middle ear pressure.
● Etiology: URI, allergies, or chronic tobacco use.
● Pathophysiology: Negative pressure develops, pulling the TM inward (retraction).
● Clinical Presentation: "Popping" or "Clicking," ear fullness, fluctuating hearing loss.
● Diagnostic Findings: Retracted TM; restricted mobility on pneumatic otoscopy.
● Treatment:
○ Systemic Decongestants: Pseudoephedrine (Sudafed).
○ Nasal Decongestants: Oxymetazoline (Afrin) (limit to 3 days).
○ Intranasal Steroids: Fluticasone (Flonase).
● Buzzwords & Hallmarks: "Aural fullness," "Symptoms improve with swallowing or
yawning."
Acute Otitis Media (AOM)
● Description: Bacterial infection of the middle ear space.
● Epidemiology: Peak age 6-24 months.
● Etiology: S. pneumoniae, H. influenzae, M. catarrhalis.
● Pathophysiology: ETD leads to fluid stasis; bacteria migrate from the nasopharynx.
● Clinical Presentation: Otalgia, fever, bulging TM, decreased hearing.
● Diagnostic Findings: Bulging, opaque, immobile TM.
● Treatment:
○ First Line: Amoxicillin (High dose: 80-90 mg/kg/day).
