Red flags The following findings are of particular concern: Diabetes or immunocompromised state or chronic kidney disease Redness and fluctuance over mastoid and protrusion of auricle Severe swelling at external auditory canal meatus Chronic pain, especially if associated with other head / neck symptoms Interpretation of findings An important differentiator is whether the ear examination is normal; middle and external ear disorders cause abnormal physical findings, which, when combined with history, usually suggest an etiology (see table).