Golden rules referring to adults

• 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