Ear problems


Cholesteatomas can affect the attic region of the tympanic membrane, making them difficult to see on examination. The two signs of concern to look for are:

  • Persistent foul-smelling discharge, not responding to treatment over several weeks
  • Unilateral hearing loss.

Referral is routine, not urgent, but should be made.

Sudden sensorineural hearing loss (SSHL)

Requires urgent (same day) referral as sometimes due to CVA. Most cases are idiopathic. Treatment includes 7/7 oral steroids or intratympanic steroid injection.

Protection of perforated eardrum

If swimming, use earplugs and a hat.

Antibiotic drops can be used in the affected ear if it is inflamed, but for a maximum of 7 – 10 days.

Rinne’s test

Use a 512 Hz tuning fork and strike it against your elbow or patella, two-thirds of the way along the limb of the tuning fork. Check it’s making a sound before trying it on the patient. Hold the tuning fork in front of the ear and then against the mastoid, ask the patient which is louder, and repeat.

Positive = A >B

Negative = B > A

(Pulse on-line learning module)

About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in ENT. Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s