TREATMENTIf the loss is the result of ex-
cessive noise, a change of the working or living
environment is indicated. Sound suppressors and
hearing protection devices should be employed.
If the loss is due to an underlying cause such as
impacted cerumen or infection, treat the cause.
Perforated Tympanic Membrane
Although this condition may occur spon-
taneously, it is normally a result of trauma.
SYMPTOMSThere may be pain, discharge,
hearing loss, and a blowing sensation in the ear.
TREATMENTIf the perforation is small,
no treatment is necessary. Unless the perforation
is due to infection, do not instill medications in
the ear. A light cotton pledget may be used to
prevent dirt or water from entering the ear. For
more serious perforations, refer the patient for
Acute External Otitis (Swimmers Ear)
This is an acute infection in the ear canal,
which sometimes involves the auricle and often
occurs after swimming.
SYMPTOMSThere is usually severe pain
and enlarged lymph nodes, and there may be a
discharge. Fever is normally present.
TREATMENTPlace a wick in the ear canal
for 48 hours. The wick should be moistened with
aluminum acetate solution every 3 hours. Follow-
ing this, instill topical antibiotics and steroids.
Treat other symptoms symptomatically.
This condition is the result of a furuncle
involving the auricle and external ear canal.
SYMPTOMSImpaired hearing, feelings of
fullness in the ear, swelling, pain, fever, redness,
and lymphadenopathy are common.
TREATMENTFuruncles on the auricle
should be treated in the same manner as
furuncles elsewhere on the body (see Common
Dermatological Conditions in this chapter).
When the furuncle is in the external canal, insert
a wick moistened with aluminum acetate solution
into the ear canal. Application of heat packs
may help to bring the infection to a point.
I&D after fluctuation. Administer systemic anti-
This is a fungous infection of the external ear
resulting from poor hygiene, swimming, and
favored by warm, moist climates.
SYMPTOMSThese include itching, pain, a
possible discharge, a stinging sensation, and the
appearance of salt and pepper particles (i.e.,
dirty gray or black exudate resulting from pro-
TREATMENTRemove debris with a solu-
tion of acetic acid and aluminum acetate. Dry the
ear with alcohol, and perform a smear to identify
specific fungus. Treat with the appropriate topical
Acute Otitis Media
This is an infection of the middle ear
that is usually the result of bacterial origin.
It normally follows URI and is more common in
SYMPTOMSIt is characterized by pain,
deafness, fever, chills, and sensations of fullness
or pressure. The tympanic membrane is red and
bulging and rupture is common. Visualization
of normal landmarks is impeded and often
impossible due tos welling. Hearing tests show a
to help promote drainage. Bed rest and
analgesics are indicated. Start systemic anti-
biotic therapy and maintain it until the
eardrum appears normal and other symptoms
This is a suppurative inflammation of the
inner ear that may be caused by chronic otitis
media, allergies, trauma, blood dyscrasias, and
SYMPTOMSThese include deafness, tin-
nitus, vertigo, nystagmus, nausea, vomiting, a
staggering gait, and a tendency to fall toward the