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To the Editor: In their Rational Clinical Examination article on hearing impairment, Dr Bagai and colleagues¹ made no explicit recommendation to visualize the ear canal and tympanic membrane in either the discussion of tests or in the Case Resolution. The recommended management of Case 1 states that once a patient reports hearing loss "no further bedside diagnostic testing is required," and that the patient should be sent for formal audiological testing, implying that the physician does not need to look in the ear. While there is passing mention that the audioscope can be used to visualize the tympanic membrane, an examination with a regular otoscope can reveal simple problems like cerumen impaction as a cause of reversible hearing loss. It may well be stating the obvious to include this in the article and the algorithm, but the beauty of this series of articles is that it reexamines what we think . . . [Full Text of this Article]

David L. Gaspar, MD
david.gaspar@uchsc.edu
Department of Family Medicine
University of Colorado
Denver

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