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.
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)