Which finding would best distinguish otitis externa from otitis media?

• A. Pain with pinna traction
• B. Bulging tympanic membrane
• C. Fever
• D. Hearing loss with ear fullness

Answer: (A)

Pain with traction on the pinna highlights inflammation of the external ear canal itself. When the canal is inflamed, pulling on the pinna or tragus causes sharp, localized pain, which is typical of otitis externa. In otitis media, the infection is behind the tympanic membrane, so moving the outer ear doesn’t provoke that same canal-specific tenderness.

A bulging tympanic membrane points to otitis media, as the middle ear filled with fluid or pus pushes the membrane outward. Fever can occur with either condition, and hearing loss with a feeling of fullness is common with middle-ear involvement, making them less helpful for distinguishing the two.