Question: You are caring for a 2 year old girl who has a history of recurrent otitis media and conductive hearing loss secondary to eustachian tube dysfunction, that ultimately required ear tube placement. At the child's first postoperaitve visit, her parents ask whether or not they need to purchase custom molded ear plugs so that she can take swimming lessons. Is there evidence to guide your response? [Answer will be posted with next week's new question]

Answer to last week's question, Take a Deep Breath (July 20, 2015):

The Cottle maneuver or the modified Cottle maneuver. The Cottle maneuver is performed by placing your fingers on the patient's cheeks, just lateral to their nasal ala and pulling laterally. This is thought to have poor reliability. The modified Cottle maneuver is performed by placing a blunt, thin, instrument, such as a wax curette or a QTip, into the external nasal valve and then into the internal nasal valve. At each location, open laterally and ask the patient to take a deep breath to assess changes in the sensation of nasal obstruction. It is thought to be both more accurate and more specific than the original Cottle maneuver.