golden rules referring to adults

Last edited 12/2020 and last reviewed 12/2020

• 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