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pay particular attention when inspecting the opposite ear canal, the nose, and other accessible body orifices.

Any cerumen should be left as is, unless it interferes with the visualization of the rest of the canal and tympanic membrane. Removal of cerumen is best left to an experienced examiner because any manipulation may result in trauma or abrasions. Figure 11-16 depicts an external ear canal with a large hematoma secondary to aggressive use of a cotton-tipped applicator stick. Notice the tympanic membrane in the background. If a discharge is present, look for the site of origin.

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Stretch Marks

Stretch Marks

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