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)


  • Roland PS, Stroman DW. Microbiology of acute otitis externa. Laryngoscope. 2002;112:1166–1177