Inspect the External Ear Structures

A small dimple in front of the tragus is usually a remnant of the first branchial arch.

Inspect the external ear for deformities, nodules, inflammation, or lesions. The presence of tophi is a highly specific but nonsensitive sign of gout. Tophi are deposits of uric acid crystals. They appear as hard nodules in the helix or antihelix. In rare cases, a white discharge may be seen in association with them. A ''cauliflower ear'' is a pinna that is gnarled as a result of repeated trauma. Figure 11-11 shows a squamous cell carcinoma and a malignant melanoma of one lobule.

Inspect for discharge. If discharge is present, note its characteristics, such as color, consistency, and clarity.

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