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I mean, there are a variety of reasons. I think the way they (med school and residency) teach ear exams is bad. I think otoscopes are suboptimal. I think the way they teach the pathophysiology is bad. I think the anatomy is poorly understood. I think to get good at ear exams you have to start by looking in everyone’s ear even if they’re normal, and that takes time and effort and planning. I think people come out of primary care training with a very poor differential diagnosis for the causes of plugged ear or ear pain, so they don’t really ask any pertinent questions. But mostly I think it’s just way easier to call everything eustachian tube dysfunction and place a referral. The patient feels like you’ve figured it out and put them on the right path and you don’t have to see them again. Hands washed.Is it because no one uses insufflation on the TM?
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