IMMEDIATE MANAGEMENT OF POTENTIALLY HARMFUL DISORDERS
The complaint of ear pain is more common among children than adults and usually relates to an infectious process. Though some conditions are serious, patients with most ear pain conditions can receive treatment and be discharged by the emergency physician without consultation (Table 32–1).
Table 32–1.Diagnosis and treatment of ear pain. |Favorite Table|Download (.pdf) Table 32–1. Diagnosis and treatment of ear pain.
|Diagnosis ||Diagnostic Clues ||Treatment ||Comments |
|Acute mastoiditis ||Fever or chills, pain, swelling, and erythema at mastoid process; typically an extension of acute otitis media; normal canal and findings of concurrent otitis media ||ENT consultation, admission, IV antibiotics, possible necessity for surgical intervention; Cefotaxime, 1 g IV q 24 h, or ceftriaxone, 1–2 g IV q 24 h ||Relatively rare; usually S. pneumoniae, S. pyogenes, S. aureus; if it develops after resolved otitis media: acute coalescent mastoiditis |
|Bullous myringitis ||Severe ear pain, TM bullae on TM surface, with surrounding erythema; middle ear space not affected ||Erythromycin (EES, adult: 400 mg q.i.d.; child: 10 mg/kg q.i.d.), doxycycline, azithromycin ||Mycoplasma (or viral) |
|Chondritis, perichondritis ||Pain or swelling to the external (cartilaginous) ear; recent ear trauma; warm, erythematous, tender auricle, pinna skin; evidence of recent trauma or piercing; if ear is deformed, suspect chondritis (cartilage infection) ||Remove foreign bodies, irrigate wounds; warm soaks and oral cephalexin; outpatient ENT follow-up; if evidence of cartilage involvement, ENT consultation, admission, IV antibiotics || |
|Foreign body ||Usually young child, witnessed insertion; foreign body in canal ||Removal is typically uncomfortable; tailor method to the characteristics of the foreign body (Frazier suction, alligator forceps, curette); prep with topical anesthetic; children may require restraint or sedation ||If canal trauma is present, treat as for otitis externa, outpatient follow-up |
|Infected sebaceous cyst ||Pain in canal; no discharge; erythematous, cystic canal surface; pain with pinna traction ||Incise and drain cysts; cephalexin or dicloxacillin; outpatient ENT follow-up ||May prevent recurrence with selenium sulfide (Selsun) or ketoconazole/steroil shampoo |
|Insect in canal ||Buzzing or movement sensation; insect in canal or on TM catheter; flush out when patient is calm ||Immobilization will relieve the discomfort; instill mineral oil in the canal with a syringe and flexible tip ||Alternatively, may remove a large insect with narrow alligator forceps through the otoscope |
|Otitis externa (swimmer’s ear) ||Common in regular swimmers; ear pain, itching. Purulent discharge, erythematous canal, pain with pinna traction; canal may be occluded by wall edema; normal hearing unless canal is occluded ||Place a cotton wick through an obstructed or near-obstructed canal; treat with topical steroid and antibiotic preparations: hydrocortisone-polymyxin neomycin (Cortisporin Otic), 4 drops q.i.d., or hydrocortisone-ciprofloxacin (Cipro FIC Otic), 3 drops b.i.d. ||Typically Pseudomonas; outpatient follow-up within 3 days; reduce recurrence risk with drying rubbing alcohol drops following water exposure consider malignant variant in diabetic, immunocompromised, or elderly patients |
|Otitis externa (malignant) ||Elderly, immunocompromised, or diabetic patient ...|
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