Managing Emergency Department Patients With Otalgia

Enlarge Image
Delivery Method:	Online
$99.00 ADD TO CART OR SUBSCRIBE AND SAVE Back To Store

Publication Date: April 2024 (Volume 26, Number 4)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 04/01/2027.

Author

Peer Reviewers

Abstract

Though the vast majority of conditions associated with otalgia are not life-threatening, there are nuances and controversies in the diagnosis and management of even the most common diseases, such as acute otitis media and otitis externa. For more severe disease processes, such as necrotizing otitis externa, acute mastoiditis, and perichondritis, early recognition and timely management are paramount in reducing morbidity and mortality. A systematic approach to the evaluation of these patients is key to establishing an accurate diagnosis, identifying patients who are at high risk for dangerous etiologies or complications, and providing optimal patient care. This issue summarizes the most recent guidelines and presents a systematic, evidence-based approach to the emergency department evaluation and management of patients with otalgia.

Case Presentations

A 3-year-old girl presents to the emergency department with fever and ear pain for the past day…

• The patient’s mother reports that the girl had a fever of 38.5°C at home earlier today, but she has remained active and is eating well. She is otherwise healthy and has never been diagnosed with otitis media before.
• Her vital signs are: temperature, 38.4C°; heart rate, 100 beats/min; blood pressure, 90/60 mm Hg; and respiratory rate, 24 breaths/min.
• Otoscopic examination shows bulging of the right tympanic membrane, with decreased mobility on insufflation. You wonder whether this patient requires antibiotics or if observation is appropriate…

A 70-year-old man with a history of diabetes mellitus presents with persistent severe left-sided otalgia and otorrhea after being diagnosed with acute otitis externa 2 weeks ago…

• The patient reports his symptoms are not improving despite ciprofloxacin/dexamethasone otic drops. He is reporting severe otalgia, left-sided headache, as well as facial pain adjacent to his temporomandibular joint.
• He is febrile to 38.3°C upon arrival to the ED, but his other vital signs are normal.
• On examination, the external auditory canal appears macerated and edematous and there is granulation tissue visible at the osseocartilaginous junction.
• You consider whether this patient could have necrotizing otitis externa and start to plan what the next steps should be…

A 19-year-old adolescent presents with trauma to his ear that he sustained during a college wrestling match…

• The patient’s coach reports that there was no loss of consciousness during the event.
• His vital signs are: temperature, 36.8C°; heart rate, 70 beats/min; blood pressure, 118/62 mm Hg; and respiratory rate, 12 breaths/min. The neurologic examination is normal.
• On a secondary survey, you note you note a tender and fluctuant area of swelling on the anterior surface of the right pinna, with overlying ecchymosis.
• You recall that this type of traumatic injury could lead to a poor cosmetic outcome, so you start to consider what the current best-practice management strategy would be for this patient…

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.