Audiology Assessment: Cerumen Impaction & Otitis Externa

Cerumen Impaction

• A 75-year-old male presented with two-week history of decreased hearing in the left ear.
• He experienced fullness and mild discomfort, but no significant pain or fever.
• Symptoms began gradually after using cotton swabs for cleaning.
• Physical exam showed an occluded external auditory canal (EAC) with hard, dark cerumen.
• No visible tympanic membrane (TM).
• Weber test lateralized to affected side (AS).
• Rinne test showed bone conduction greater than air conduction (B>A) on affected side (AS).
• Treatment involved attempts to remove cerumen via cerumenolytic agent, irrigation, or manual removal.
• Patient was educated about avoiding cotton swabs for ear cleaning.
• Referral to ENT if impaction not removable.
• Routine ear cleanings by a healthcare professional every 6-12 months recommended.

Otitis Externa (Swimmer's Ear)

• A 7-year-old female presented with five-day history of progressive right ear pain.
• Pain was sharp and worsened with touching or pulling on the ear.
• Associated pruritus and fullness.
• Reported mild discharge.
• History of swimming during recent beach vacation.
• Physical exam showed EAC edema and erythema, with purulent discharge.
• Pain with manipulation of the tragus and auricle.
• TM difficult to visualize.

Malignant External Otitis

• A 72-year-old male with poorly controlled diabetes presented with three weeks of severe right ear pain and drainage.
• Pain was deep, throbbing, and radiated to jaw and neck.
• Difficulty chewing, intermittent fevers, and night sweats reported.
• No dizziness or hearing loss.
• Prior episodes of swimmer's ear, but current presentation was worse.
• Physical exam showed edema and tenderness to the right preauricular area, trismus, erythema, and granulation tissue in the external auditory canal (EAC).
• Purulent discharge noted.
• TM not visualized.
• Treatment involved culture of drainage, biopsy of granulations, and CT/MRI/bone scan to determine severity.
• 1-6 months of oral/IV antibiotics.

Foreign Body in External Auditory Canal (FB in EAC)

• A 6-year-old boy presented with a small bead lodged in his right external auditory canal (EAC) following a recent activity.
• Complained of initial mild discomfort, gradually increasing irritability and foul-smelling discharge.
• Denies dizziness or fever.
• The physical exam revealed a shiny, round object in the EAC.
• EAC erythematous and edematous, with purulent discharge.
• No visible TM perforation.
• Removal of the object was discussed, noting consideration for T-tubes, perforated TM, and veggie matter.
• Referral to ENT for button batteries, insects, and penetrating foreign objects.

Acute Otitis Media (AOM)

• A 4-year-old girl presented with right ear pain for two days.
• Symptoms started following nasal congestion and low-grade fever.
• No significant vomiting or diarrhea.
• Physical exam showed a bulging and erythematous tympanic membrane (TM).
• Treatment involves observation and/or antibiotics.
• If no prior antibiotic use in the month, amoxicillin is first-line treatment.
• If previous antibiotic use, use amoxicillin-clavulanate.
• If penicillin allergy, consider cephalosporins or clindamycin.
• Acute otitis media is commonly caused by Streptococcus pneumoniae.
• Observation and/or antibiotics recommended for children with bulging and erythematous TM.

Chronic Otitis Media

• A 35-year-old male presented with six months of intermittent purulent, foul-smelling discharge from his left ear.
• Decreased hearing in affected ear, but no ear pain, vertigo, or fever.
• History of recurrent childhood ear infections and T-tube placement.
• Construction work with frequent exposure to dust.
• Purulent debris in EAC with central TM perforation.
• Reduced mobility of the TM with insufflation.
• Granulation tissue noted around perforation.
• Treatment involved removal of infected debris (if necessary), counseling on ear protection, and topical antibiotics.

Otitis Media with Effusion (OME)

• A 5-year-old male presented due to concerns about reduced hearing.
• No ear pain, discharge, or fever.
• History of nasal congestion and upper respiratory infection.
• Physical exam showed a dull and retracted tympanic membrane (TM) with loss of light reflex.

Acoustic Neuroma

• A 45-year-old female with six-month history of gradual hearing loss on her right ear presents with difficulty in understanding conversations with others in noisy environments or when multiple people are talking.
• She reports mild dizziness and unsteadiness.
• No signs of ear pain, discharge, vertigo, or tinnitus.

Benign Paroxysmal Positional Vertigo (BPPV)

• A 62-year-old female with two-week history of brief episodes of dizziness.
• Dizziness triggered by positional changes (rolling, looking up, bending down).
• Nausea but no vomiting.
• Episodes less than a minute, multiple times per day.
• No associated headache, hearing loss, or fullness.

Labyrinthitis

• A 38-year-old male presents with a sudden onset of severe vertigo.
• Vertigo was constant and worsened with head movements.
• Associated nausea and vomiting, but no hearing loss, tinnitus, or ear pain.
• Mild upper respiratory symptoms (nasal congestion and sore throat) prior to vertigo onset.
• Difficulty walking due to unsteadiness.

### Barotrauma

• A 35-year-old male presented with right ear pain and hearing difficulty.
• Symptoms began during flight descent.
• Sudden "popping" sensation in ear and sharp pain.
• Muffled hearing.
• No prior history of ear problems or ear infections associated with flying.
• Recent cold and congestion before flying were reported.

Ramsay Hunt Syndrome

• A 58-year-old male presented with facial weakness and a painful rash around his ear.
• Rash described as itchy and burning, with fluid-filled blisters, accompanied by difficulty closing his right eye and drooling.
• Decreased hearing and "ringing" sensation in the right ear.
• Mild dizziness and imbalance.

Mastoiditis

• A 7-year-old female presented with worsening right ear pain, fever, and irritability.
• Symptoms began two weeks prior and included acute otitis media, followed by swelling, redness, and tenderness behind the right ear.
• History of recurrent AOM.
• Symptoms worsened with reluctance to turn the head due to pain.
• Physical exam showed a bulging, erythematous, and immobile TM.
• Treatment involved CT scan, culture of blood, CSF, or abscesses, referral to ENT.

Meniere's Disease

• A 45-year-old female with recurring vertigo episodes lasting 1-4 hours.
• Associated symptoms include room spinning, nausea, vomiting, a feeling of fullness in the affected ear, and tinnitus.
• Intermittent hearing loss, worse during or after episodes.
• No headache, vision changes, or recent upper respiratory infections.

Conductive Hearing Loss

• A 32-year-old male with three-week history of decreased hearing in his left ear.
• Described as a "muffled sound" sensation, similar to listening through a wall.
• No pain, drainage, tinnitus.
• Occasional itching in affected ear.
• No trauma, recent upper respiratory infections, or exposure to loud noises.
• No improvement with over-the-counter ear drops.

Sensorineural Hearing Loss (Presbycusis)

• A 72-year-old male with two-year history of progressive hearing loss.
• Difficulty understanding speech, especially in noisy environments.
• Increasing volume on TV and phone helps.
• No ear pain, drainage, vertigo, or tinnitus.
• No history of ear infections, trauma, or exposure to loud noises.

External Ear Neoplasms (Malignant and Benign)

• Malignant: Squamous cell carcinoma (SCC).
• Benign: adenomatous tumor from ceruminous gland.
• Middle ear neoplasms: rare, potentially benign or malignant, associated with pulsatile tinnitus, hearing loss, and mass behind the tympanic membrane.
• Inner ear neoplasms: acoustic neuroma (vestibular schwannoma), characterized by hearing loss, tinnitus, and possible CN neuropathies.
• Imaging like MRI is frequently useful in diagnosis.

This quiz covers key concepts in audiology focusing on cerumen impaction and otitis externa, including patient presentation, examination findings, and treatment options. Test your knowledge of ear conditions in both adults and children, and learn best practices for ear care and hygiene.