# A 25-year-old client presents to the emergency department complaining of severe ear pain that began 2 days ago after swimming at a local pool. The client reports that the pain worsens when touching the ear. Which assessment finding would be most characteristic of otitis externa? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541677 > language: ko > subject: Adult Health ## 문제 A 25-year-old client presents to the emergency department complaining of severe ear pain that began 2 days ago after swimming at a local pool. The client reports that the pain worsens when touching the ear. Which assessment finding would be most characteristic of otitis externa? A 25-year-old client presents to the emergency department complaining of severe ear pain that began 2 days ago after swimming at a local pool. The client reports that the pain worsens when touching the ear. ## 보기 1. Hearing loss with no pain on palpation 2. Purulent drainage with perforated tympanic membrane 3. Pain when pulling on the auricle (tragus sign) **✔ 정답** 4. Fever with bulging tympanic membrane **정답: 3** ## 해설 Pain when pulling on the auricle (tragus sign) is the most characteristic finding of otitis externa, as it directly indicates inflammation in the external ear canal. Other findings are more typical of otitis media or other conditions. ## 심화 해설 Clinical Reasoning Analysis The client's history of recent swimming and severe ear pain that worsens with physical manipulation of the external ear structures points toward an inflammatory process of the ear canal rather than the middle ear. The most characteristic assessment finding for otitis externa is pain elicited by manipulating the auricle or tragus, a clinical indicator often referred to as the tragus sign. This finding directly reflects the pathophysiology of the condition, where the inflamed, edematous skin of the external auditory canal becomes highly sensitive to mechanical deformation [1]. Differentiating between otitis externa and acute otitis media is a critical clinical judgment skill for the NCLEX-RN. In otitis externa, the infection and inflammation are localized to the external auditory canal. Because the canal's skin is tightly adherent to the underlying cartilage, any movement of the auricle or pressure on the tragus stretches this inflamed tissue, causing sharp, localized pain. This is a pathognomonic physical examination finding that is consistently highlighted in clinical practice guidelines for diagnosis [1]. The absence of this finding, or the presence of a bulging tympanic membrane, would redirect the clinical suspicion toward a middle ear process. The incorrect options represent findings more consistent with other ear pathologies. Hearing loss without pain on palpation is a nonspecific finding that can occur with cerumen impaction or serous otitis media but lacks the hallmark inflammatory sign of external ear involvement. Purulent drainage suggests a ruptured tympanic membrane from a middle ear infection, where the initial pain often subsides after perforation and is not primarily triggered by auricle manipulation. Fever with a bulging, erythematous tympanic membrane is the classic presentation of acute otitis media, an infection of the middle ear space that is distinct from the external canal inflammation seen in this client [1]. The client's history of water exposure from swimming is a well-established predisposing factor for otitis externa, as moisture macerates the protective epithelial lining of the canal, creating an environment conducive to bacterial or fungal overgrowth [1,2].References (research sources) - [1]A Systematic Review and Quality Assessment of Clinical Practice Guidelines for Otitis Externa to Support the WHO Package of Ear and Hearing Care Interventions.GuidelineDillard LK, Mishra P, Chander Shekhar C, Chibisova S, Hannadjas I, Onifade A, Sajjad O, Tavartkiladze G, Der C, Chadha S. (2026) · DOI: 10.1097/mao.0000000000004972 ## 임상 시나리오 Otitis Externa AssessmentDifferentiating External from Middle Ear Pathology The hallmark of otitis externa is pain with manipulation of the external ear, known as the tragus sign. This occurs because the inflamed skin of the ear canal is stretched when the auricle is pulled or the tragus is pressed. In contrast, acute otitis media typically presents with a bulging, erythematous tympanic membrane and systemic signs like fever. Pain is not usually worsened by touching the external ear structures. CautionNever irrigate the ear canal if tympanic membrane perforation is suspected. In otitis externa, a wick may be needed to deliver topical antibiotics past the edematous canal. ## 핵심 개념 - **Otitis Externa** — Inflammation of the external auditory canal, often called swimmer's ear, typically presenting with tragal tenderness. - **Tragus Sign** — Sharp pain elicited by pulling on the auricle or pressing on the tragus, a pathognomonic finding for otitis externa. ## 같은 주제 문제 - [A nurse is assessing a client with suspected otitis externa. Which assessment finding woul…](https://mymerci.kr/pages/nclex_q.php?qn_id=541678) - [A nurse is caring for a client diagnosed with otitis externa. 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