EARACHE

Ask the following questions:

1. Are there abnormalities on the ear examination? The ear examination may reveal severe otitis externa, an epithelioma of the pinna, a foreign body, or impacted wax. It may also show inflammation and bulging of the eardrum. A vesicular rash of the drum and external auditory canal may indicate herpes zoster.
2. Is there pain on moving the pinna? Pain on moving the ear suggests otitis externa, foreign body, impacted wax, or keratosis obturans.
3. Is there hearing loss? Hearing loss with an abnormal drum would suggest serous or bacterial otitis media. It may also suggest a cholesteatoma. Hearing loss with a normal ear exam suggests aero-otitis.
4. Could the pain be a referred pain? Dental caries, dental abscesses, impacted teeth, tonsillitis, and temporomandibular joint syndrome may refer pain to the ear.

DIAGNOSTIC WORKUP

It should go without saying that diagnosis begins with an adequate otoscopic examination. If the drum is obscured by wax, gentle lavage after using Cerumenex will usually clear the canal. If there is an exudate, a culture and sensitivity should be ordered. Perhaps a throat culture should be done also. X-rays of the mastoids and petrous bones should be done if the exudate is believed to be from a deeper source. Perhaps a CT scan is also needed. If there is hearing loss, an audiogram needs to be done and a tympanogram will be useful in diagnosing serous otitis media. A trial of carbamazepine (Tegretol®) or phenytoin (Dilantin®) may be useful in diagnosing glossopharyngeal neuralgia or tic douloureux. If the discharge is thought to be cerebrospinal fluid, a CT scan and RISA study should be done.

Referral to an ear, nose, and throat specialist or neurologist should be considered before ordering expensive diagnostic tests.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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