STUDY - Technical - New Dacian's Medicine
Otorrhea
(Classical / Allopathic Medicine)
Otorrhea
- drainage from the ear - may be bloody (otorrhagia),
purulent, clear, or serosanguineous. Its onset, duration,
and severity provide clues to the underlying cause. This
sign may result from a disorder that affects the external
ear canal or the middle ear, including an allergy,
infection, neoplasm, trauma, or collagen disease. Otorrhea
may occur alone or with other symptoms such as ear pain.
HISTORY:
Ask the patient when the otorrhea began. Ask him how he recognized it.
Ask the patient if he cleaned the drainage from deep within the ear canal or if he wiped it from the auricle.
Ask the patient to describe the color, consistency, and odor of the drainage. Is it clear, purulent, or bloody? Ask him if it occurs in one or both ears and if it's continuous or intermittent.
If the patient wears cotton in his ear to absorb the drainage, ask how often he changes it.
Explore associated otologic symptoms, especially pain. Ask about vertigo and tinnitus.
Review the patient's medical history for recent upper respiratory tract infection, head trauma, cancer, dermatitis, and immunosuppressant therapy.
Ask the patient how he cleans his ears.
Ask the patient if he's an avid swimmer.
Ask the patient when the otorrhea began. Ask him how he recognized it.
Ask the patient if he cleaned the drainage from deep within the ear canal or if he wiped it from the auricle.
Ask the patient to describe the color, consistency, and odor of the drainage. Is it clear, purulent, or bloody? Ask him if it occurs in one or both ears and if it's continuous or intermittent.
If the patient wears cotton in his ear to absorb the drainage, ask how often he changes it.
Explore associated otologic symptoms, especially pain. Ask about vertigo and tinnitus.
Review the patient's medical history for recent upper respiratory tract infection, head trauma, cancer, dermatitis, and immunosuppressant therapy.
Ask the patient how he cleans his ears.
Ask the patient if he's an avid swimmer.
PHYSICAL
ASSESSMENT:
If the patient's symptoms are unilateral, examine the uninvolved ear first.
Inspect the external ear, and apply pressure on the tragus and mastoid area to elicit tenderness.
Insert an otoscope, using the largest speculum that will comfortably fit into the ear canal. If necessary, clean cerumen, pus, or other debris from the canal. Check for edema, erythema, crusts, or polyps. Inspect the tympanic membrane, which should look like a shiny, pearl-gray cone. Note color changes, perforation, absence of the normal light reflex (a cone of light appearing toward the bottom of the drum), or a bulging membrane.
Test hearing acuity. Have the patient occlude one ear while you whisper some common two-syllable words toward the unoccluded ear. Stand behind him so he can't read your lips, and ask him to repeat what he heard. Perform the test on the other ear using different words. Then use a tuning fork to perform Weber's test and the Rinne test.
Palpate the neck and preauricular, parotid, and postauricular (mastoid) areas for lymphadenopathy. Test the function of cranial nerves VII, IX, X, and XI.
If the patient's symptoms are unilateral, examine the uninvolved ear first.
Inspect the external ear, and apply pressure on the tragus and mastoid area to elicit tenderness.
Insert an otoscope, using the largest speculum that will comfortably fit into the ear canal. If necessary, clean cerumen, pus, or other debris from the canal. Check for edema, erythema, crusts, or polyps. Inspect the tympanic membrane, which should look like a shiny, pearl-gray cone. Note color changes, perforation, absence of the normal light reflex (a cone of light appearing toward the bottom of the drum), or a bulging membrane.
Test hearing acuity. Have the patient occlude one ear while you whisper some common two-syllable words toward the unoccluded ear. Stand behind him so he can't read your lips, and ask him to repeat what he heard. Perform the test on the other ear using different words. Then use a tuning fork to perform Weber's test and the Rinne test.
Palpate the neck and preauricular, parotid, and postauricular (mastoid) areas for lymphadenopathy. Test the function of cranial nerves VII, IX, X, and XI.
SPECIAL
CONSIDERATIONS:
Apply a warm, moist compress or heating pad to the patient's ear to relieve inflammation and pain. Use cotton wicks to gently clean the drainage or to apply topical drugs. Keep eardrops at room temperature; installation of cold eardrops may cause vertigo.
Apply a warm, moist compress or heating pad to the patient's ear to relieve inflammation and pain. Use cotton wicks to gently clean the drainage or to apply topical drugs. Keep eardrops at room temperature; installation of cold eardrops may cause vertigo.
PEDIATRIC
POINTERS:
When you examine or clean a child's ear, remember that the auditory canal lies horizontally and that the pinna must be pulled downward and backward.
Restrain a child during an ear procedure by having him sit on a parent's lap with the ear to be examined facing you. Have him put one arm around the parent's waist and the other arm down at his side and then ask the parent to hold the child in place. Alternatively, if you're alone with the child, you can have him lie on his abdomen with his arms at his sides and his head turned so the affected ear faces the ceiling. Bend over him, restraining his upper body with your elbows and upper arms.
Otitis media is the most common cause of otorrhea in infants and young children. Children are also likely to insert foreign bodies into their ears, resulting in infection, pain, and purulent discharge.
When you examine or clean a child's ear, remember that the auditory canal lies horizontally and that the pinna must be pulled downward and backward.
Restrain a child during an ear procedure by having him sit on a parent's lap with the ear to be examined facing you. Have him put one arm around the parent's waist and the other arm down at his side and then ask the parent to hold the child in place. Alternatively, if you're alone with the child, you can have him lie on his abdomen with his arms at his sides and his head turned so the affected ear faces the ceiling. Bend over him, restraining his upper body with your elbows and upper arms.
Otitis media is the most common cause of otorrhea in infants and young children. Children are also likely to insert foreign bodies into their ears, resulting in infection, pain, and purulent discharge.
PATIENT
COUNSELING:
Advise the patient with chronic ear problems to avoid forceful nose blowing when he has an upper respiratory tract infection so that infected secretions aren't channeled into the middle ear. Instruct him to blow his nose with his mouth open. Also, remind him to cleanse his ears with a washcloth only and not to put anything in his ear (such as a hairpin or a cotton-tipped applicator) that may cause injury.
Advise the patient with chronic ear problems to avoid forceful nose blowing when he has an upper respiratory tract infection so that infected secretions aren't channeled into the middle ear. Instruct him to blow his nose with his mouth open. Also, remind him to cleanse his ears with a washcloth only and not to put anything in his ear (such as a hairpin or a cotton-tipped applicator) that may cause injury.
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.