STUDY - Technical - New Dacian's Medicine
Earache
(otalgia) (Classical / Allopathic Medicine)
Earaches (otalgia)
usually result from disorders of the external and middle ear
associated with infection, obstruction, or trauma. Their
severity ranges from a feeling of fullness or blockage to
deep, boring pain; at times, they may be difficult to localize
precisely. This common symptom may be intermittent or
continuous and may develop suddenly or gradually.
HISTORY:
Ask the patient to characterize his earache. How long has he had it? Is it intermittent or continuous? Is it painful or slightly annoying? Can he localize the pain site? Does he have pain in another area such as the jaw?
Ask the patient about a recent ear injury or other trauma.
Ask the patient if swimming or showering triggers ear discomfort. Has he been swimming lately in a lake or river?
Ask the patient if there's discomfort associated with itching. If so, find out where the itching is most intense and when it began.
Ask the patient about ear drainage and, if present, have him characterize it.
Ask the patient if he recently had a head cold or problems with his eyes, mouth, teeth, jaws, sinuses, or throat. (Disorders in these areas may refer pain to in the ear along the cranial nerves.)
Ask the patient about associated signs and symptoms. Does he hear ringing or noise in his ears? Has he been dizzy? Does the earache worsen when he changes position? Does he have difficulty swallowing, hoarseness, neck pain, or pain when he opens his mouth?
Ask the patient to characterize his earache. How long has he had it? Is it intermittent or continuous? Is it painful or slightly annoying? Can he localize the pain site? Does he have pain in another area such as the jaw?
Ask the patient about a recent ear injury or other trauma.
Ask the patient if swimming or showering triggers ear discomfort. Has he been swimming lately in a lake or river?
Ask the patient if there's discomfort associated with itching. If so, find out where the itching is most intense and when it began.
Ask the patient about ear drainage and, if present, have him characterize it.
Ask the patient if he recently had a head cold or problems with his eyes, mouth, teeth, jaws, sinuses, or throat. (Disorders in these areas may refer pain to in the ear along the cranial nerves.)
Ask the patient about associated signs and symptoms. Does he hear ringing or noise in his ears? Has he been dizzy? Does the earache worsen when he changes position? Does he have difficulty swallowing, hoarseness, neck pain, or pain when he opens his mouth?
Using an otoscope
correctly
When the patient reports an earache, use an otoscope to inspect ear structures closely. Follow these techniques to obtain the best view and to ensure patient safety.
When the patient reports an earache, use an otoscope to inspect ear structures closely. Follow these techniques to obtain the best view and to ensure patient safety.
Child
To inspect an infant's or a young child's ear, grasp the lower part of the auricle and pull it down and back to straighten the upward S curve of the external canal. Then gently insert the speculum into the canal no more than ½″ (1.3 cm).
Adult
To inspect an adult's ear, grasp the upper part of the auricle and pull it up and back to straighten the external canal. Then insert the speculum about 1″ (2.5 cm). Also, use this technique for children older than age 3.
PHYSICAL ASSESSMENT:
Inspect the external ear for redness, drainage, swelling, or deformity.
Apply pressure to the mastoid process and tragus to elicit tenderness.
Using an otoscope, examine the external auditory canal for lesions, bleeding or discharge, impacted cerumen, foreign bodies, tenderness, and swelling.
Examine the tympanic membrane. Is it intact? Is it pearly gray (normal)? Look for tympanic membrane landmarks: the cone of light, umbo, pars tensa, and the handle and short process of the malleus. (See Using an otoscope correctly.)
Perform the watch tick, whispered voice, Rinne, and Weber's tests to assess the patient for hearing loss.
To inspect an infant's or a young child's ear, grasp the lower part of the auricle and pull it down and back to straighten the upward S curve of the external canal. Then gently insert the speculum into the canal no more than ½″ (1.3 cm).
Adult
To inspect an adult's ear, grasp the upper part of the auricle and pull it up and back to straighten the external canal. Then insert the speculum about 1″ (2.5 cm). Also, use this technique for children older than age 3.
PHYSICAL ASSESSMENT:
Inspect the external ear for redness, drainage, swelling, or deformity.
Apply pressure to the mastoid process and tragus to elicit tenderness.
Using an otoscope, examine the external auditory canal for lesions, bleeding or discharge, impacted cerumen, foreign bodies, tenderness, and swelling.
Examine the tympanic membrane. Is it intact? Is it pearly gray (normal)? Look for tympanic membrane landmarks: the cone of light, umbo, pars tensa, and the handle and short process of the malleus. (See Using an otoscope correctly.)
Perform the watch tick, whispered voice, Rinne, and Weber's tests to assess the patient for hearing loss.
SPECIAL
CONSIDERATIONS:
Administer an analgesic, and apply heat to relieve discomfort. Instill eardrops, if necessary.
Administer an analgesic, and apply heat to relieve discomfort. Instill eardrops, if necessary.
PEDIATRIC
POINTERS:
Common causes of earache in children are acute otitis media and insertion of foreign bodies that become lodged or infected.
In a young child, be alert for nonverbal clues to earache, such as crying or ear tugging.
To examine the child's ears, place him in a supine position with his arms extended and held securely by his parent. Then hold the otoscope with the handle pointing toward the top of the child's head, and brace it against him using one or two fingers.
Because an ear examination may upset the child with an earache, save it for the end of your physical assessment.
Common causes of earache in children are acute otitis media and insertion of foreign bodies that become lodged or infected.
In a young child, be alert for nonverbal clues to earache, such as crying or ear tugging.
To examine the child's ears, place him in a supine position with his arms extended and held securely by his parent. Then hold the otoscope with the handle pointing toward the top of the child's head, and brace it against him using one or two fingers.
Because an ear examination may upset the child with an earache, save it for the end of your physical assessment.
PATIENT
COUNSELING:
Teach the patient (or his parents) how to instill eardrops if they're prescribed for home use.
Teach the patient (or his parents) how to instill eardrops if they're prescribed for home use.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)