Children and adults often present with complaints of ear pain. Your differential diagnoses should include otitis media and otitis externa, in addition to other possibilities such as foreign body obstruction and cerumen impactions. Give a brief overview of otitis media and otitis externa, including signs and symptoms of the most common causative agents for both. In addition, discuss the physical exam findings that you might see with the conditions when visualizing various parts of the ear such as ear canal or the tympanic membrane. How will your assessment of the ear differ in children versus adults? What would be essential health history questions to ask patients that present with ear pain and why? Support your answers with appropriate references.
The book i need you to use is Lippincott Williams and Wilkins
its advanced health and physical assessment.
APA format, times roman and 12 font.
double spacing, two pages
Ear pain may arise if the external, middle or inner ear, and other structures close to it are inflamed. There are four main causes of ear pain: otitis media, otitis externa, obstruction from foreign bodies, and cerumen impactions. Otitis media refers to a group of inflammations of the middle ear, usually classified as acute otitis media (AOM), otitis media with effusion (OME) or chronic suppurative otitis media (CSOM). The onset of AOM is usually marked by swellings on the Eustachian tube (Evans, 2016). In children the signs include ear pain, particularly when lying down, pulling sensation on the ear, sleeping difficulty, and fever. On the other hand, OME is the accumulation of a non-infectious fluid in the middle ear for periods not less than three months. It has no distinguishable symptoms, but may cause ear loss. CSOM, usually not associated with pain, may result from complications from AOM, and is the inflammation of the ear for a period not less than two weeks. It is usually accompanied by discharge from the ear. Otitis externa, is the inflammation of external ear canal, the auricle, on in some cases, both (Evans, 2016). Common symptoms include redness of the outer ear, scaly skin around the ear canal, sensation of pressure inside the ear, and ear pain. Cerumen impaction is the buildup of ear wax usually causing blockage to the ear canal causing, ear pain, ringing sensation in the ear, itchiness of the ear, and smelly discharge from the ear.
Diagnosis of otitis media may be achieved through direct observation, observation of ear pain, fever, and impaired hearing. Otitis externa, usually traced to swimming, or swimmers ear, may be diagnosed by observing the external ear using an otoscope.
Bacteria such as streptococcus pneumoniae, hemophilus, influenza, pseudomonas, and Moraxella, account for up to 85% of otitis media cases, while viruses are responsible for the remaining 15% (Evans, 2016).). Acute forms of otitis externa are due to bacteria, among them pseudomonas aeruginosa, and stephylococcusaerus.
Treatment of otitis media usually begins with a physical exam of the ear canal and tympanic membrane. Some ear infections can be physically identified by looking out for signs of inflamed tympanic membrane, redness of mucous membrane, and poor tympanic movement of tympanic membrane. As the tympanic membrane bulges, the epithelial membrane should be checked for bulging as well. For otitis externa, visible signs include erythema, granulation tissue, narrowing auditory channel, and tenderness of tragus and auricle (Lundberg, Laurent, Sandström & Hellström, 2014).
Proper assessment of patients is vital in the treatment of ear pain. This assessment is typically done on ear canals and tympanic membrane. For children, they must sit in a comfortable position, preferably a parents’ lap, with the head firmly supported to avoid head injury due to sudden jerky movements. The child should be held comfortably to reduce anxiety, and enhance cooperation (Lieberthal, et.al, 2013). Adults may be assessed while standing, as they are less likely to suffer head injury from erratic movements.
In clinical evaluation of patients with ear infection, it is necessary for medical professionals to ask questions regarding the patients’ health history. The nurse should ask for the duration of the pain, as it helps determine whether the infection is acute or chronic. The exact location of the pain will determine if the pain is on the ear, below, or behind (Rosenfeld, et.al, 2014). Recent health challenges such as upper respiratory tract infection be useful as sore throat, running nose, sinusitis could portend acute otitis media. Further, if a patient has been swimming regularly, then otitis externa could be the case. Ear discharge could signal the presence of otitis media while a raptured ear-drum could portend otitis externa. Additionally, past health conditions such as eczema could predispose the patient to otitis externa. Recurrent adenoiditis may increase risk of recurrent middle ear infection, while fever could point to otitis media (Rosenfeld, et.al, 2014).
Evans, L. (2016). Healthy living: Eye and ear care: All eyes and ears!. PS Post Script, (Aug 2016), 31.
Lundberg, T., Laurent, C., Sandström, H., & Hellström, S. (2014). What does otalgia in children represent?: A study of acute otitis media in general practice related to symptoms and tympanic membrane status over time.
Lieberthal, A. S., Carroll, A. E., Chonmaitree, T., Ganiats, T. G., Hoberman, A., Jackson, M. A., & Schwartz, R. H. (2013). The diagnosis and management of acute otitis media. Pediatrics, 131(3), e964-e999. Kaur, R., Morris, M., & Pichichero, M. E. (2017).
Rosenfeld, R. M., Schwartz, S. R., Cannon, C. R., Roland, P. S., Simon, G. R., Kumar, K. A., … & Robertson, P. J. (2014). Clinical practice guideline: acute otitis externa. Otolaryngology—Head and Neck Surgery, 150(1_suppl), S1-S24.