Table 8 Algorithm for middle ear conditions/conductive causes of hearing loss
Ear canal examination | Tympanic membrane examination | Middle ear | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
Condition | Pain reported | Ear canal inflammation | Occluding wax | Occluding foreign body | Discharge | Perforation | Light reflex visible | Malleus bone visible | Shape | Colour | Fluid present |
Normal ear and normal hearing | No | No | No | No | No | No | Yes | Yes | TM shape normal | Pearly white | No |
Acute otitis media (AOM) | Yes in ear canal | No | No | No | No | No | Yes/No | No | Bulging | Red | Yes or no |
Otitis media with effusion | No | No | No | No | No | No | Yes or no | Yes | Retracted | Dull/Opaque | Yes or unclear |
Chronic otitis media - wet | No | No | No | No | Yes for > 2 weeks | Yes | No or unable to see | Yes or no or unable to see | TM shape normal, bulging or irregular or unable to see | Pearly white or unable to see | No or unable to see |
Impacted wax | No | No | Yes | No | No | Unable to see | Unable to see | Unable to see | Unable to see | Unable to see | Unable to see |
Foreign body (FB) | No | No | No | Yes | No | Unable to see | Unable to see | Unable to see | Unable to see | Unable to see | Unable to see |
Dry perforation | No | No | No | No | No | Yes | No | Yes or no | TM shape normal, budging or irregular | Pearly white | No |
Otitis externa | Yes in ear canal | Yes | No | No | Yes or no (scanty discharge or scaling skin) | No or unable to see | Yes or unable to see | Yes or unable to see | Normal or unable to see | Normal or unable to see | No or unable to see |