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Patient with Otitis Externa

ZM is an 8-year-old male who is brought to the clinic by his mother for complaints of acute left ear pain. She has recently picked him up from a week-long stay at camp, and he stated his ear hurt so bad he was crying. When his mother looked at this ear, she noticed the outside canal was very swollen. He could not even touch his ear. His mother states: “He is never sick, and he never cries.”

Past Medical History

• All immunizations current

• No history of surgeries

• No history of allergies

• No history of significant illness

Medications

• Multivitamin, daily

• Occasional allergy medication with children’s loratadine

Physical Examination

• Pulse: 100; respiration rate: 22; temperature: 100.2 °F data scan

• Left ear canal swollen; unable to access with otoscope to observe tympanic membrane

• Swelling noted in lymph nodes below ear

• Ear is red and warm to touch

Diagnosis

• External otitis

Discussion Questions

1. What factors in ZM’s recent history should the clinician consider, and what additional questions should the clinician ask the mother?

2. What treatment options are indicated for ZM?

3. What patient teaching should the clinician provide?
What factors in ZM’s recent history should the clinician consider, and what additional questions should the clinician ask the mother?
In ZM’s recent history, the clinician should consider that ZM has just returned from a week-long stay at camp and is now presenting with acute left ear pain and swelling. This suggests that the onset of the condition may have been recent and could have been caused by exposure to bacteria or water during the stay at camp. The clinician should also consider ZM’s previous health history, including that he has never been sick and is up to date on all immunizations.
The clinician should ask the mother the following questions:
Did ZM have any exposure to water while at camp?
Did ZM complain of any other symptoms besides ear pain, such as itching or discharge from the ear?
Was ZM participating in any activities at camp that could have caused trauma to the ear canal?
Is ZM taking any other medications besides the multivitamin and occasional allergy medication?
What treatment options are indicated for ZM?
Based on the diagnosis of external otitis, the following treatment options are indicated for ZM:
Antibiotic therapy: topical or oral antibiotics may be prescribed to treat the infection and reduce inflammation
Pain management: over-the-counter pain medication or a prescription pain reliever may be recommended to manage the ear pain
Antihistamines: if ZM is experiencing itching or discomfort, antihistamines may be prescribed to reduce these symptoms
What patient teaching should the clinician provide?
The clinician should provide the following patient teaching to the mother and ZM:
Explain the cause of the external otitis and the importance of taking all prescribed medications as directed
Instruct ZM and the mother on proper ear hygiene, including avoiding the use of cotton swabs and keeping the ear dry
Explain the importance of follow-up appointments to monitor the condition and ensure it is resolving
Advise ZM and the mother to avoid activities that could cause further trauma to the ear canal, such as swimming
Explain the signs and symptoms of worsening of the condition and when to return to the clinic for further evaluation.
References:
Echols, R. (2020). External Otitis: A Review. American Family Physician, 101(7), 450-457.
Hockenberry, M. J., & Wilson, D. (2020). Wong’s Nursing Care of Infants and Children. St. Louis, MO: Elsevier.
Politzer, N. A., & Sataloff, R. T. (2019). Ear Disorders. In Otolaryngology: Head and Neck Surgery. Philadelphia, PA: Elsevier.

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