The nurse is performing an examination of a patient's ears. Which of the following findings needs immediate referral to a specialist?
a. purulent drainage from the ear
b. cerebrospinal fluid leaking from the ear
c. an ear that is permanently swollen and deformed resembling a "cauliflower"
d. pain or tenderness of the auricle of an ear
B
A skull fracture of the temporal bone causes cerebrospinal fluid to leak from the ear canal. Cerebrospinal fluid feels oily and gives a positive glucose reaction on TesTape or Dextrostix. This finding warrants immediate referral to a neurologist or neurosurgeon. Purulent drainage from an ear usually indicates an ear infection, but the patient does not need to be referred to a specialist immediately. An ear that looks like a cauliflower is called perichondrial hematoma and is a common condition among wrestlers and boxers. It is caused by blunt trauma to the external ear resulting in a blood clot formation and fluid collection under the perichondrium. Auricular pain or tenderness is a common finding in external ear infections and is called acute otitis externa.
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