History Taking
The following issues should be included:
- Classic symptoms of ear disease: deafness, tinnitus, discharge (otorrhoea), pain (otalgia) and vertigo.
- Previous ear surgery, or head injury.
- Family history of deafness.
- Systemic disease (eg, stroke, multiple sclerosis, cardiovascular disease).
- Ototoxic drugs (antibiotics (eg, gentamicin), diuretics, cytotoxics).
- Exposure to noise (eg, pneumatic drill or shooting).
- History of atopy and allergy in children.
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Inspecting the external ear
Inspect the external ear before examination with an otoscope/auriscope. Swab any discharge and remove any wax. Look for obvious signs of abnormality.
- Size and shape of the pinna.
- Extra cartilage tags/pre-auricular sinuses or pits.
- Signs of trauma to the pinna.
- Suspicious skin lesions on the pinna, including neoplasia.
- Skin conditions of the pinna and external canal.
- Infection/inflammation of the external ear canal, with discharge.
- Signs/scars of previous surgery.
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