Ear Problems

Otitis Media
Any upper respiratory tract infection (often bacterial - strep) but may be viral can cause inflammation of the respiratory mucosa, with obstruction of the eustacian tube isthmus, with results in accumulation of middle ear secretions. This causes negative pressure which pulls viruses and bacteria into the middle ear.
This increases the pressure causing otalgia and a bulging TM - the most obvious sign.
75 - 80% resolve by 72 hours - most are better by 3 days.

It is frequently overdiagnosed.

Complications include hearing loss, recurrent otitis media, perforation, labyrinthitis, mastoiditis, facial palsy, meningitis, cerebral abscess and venous sinus thrombosis.

Treatment is mostly with time. Watch and wait antibiotics may be useful.
Amoxicillin is the first choice if antibiotics actually needed (bilateral infection, longer than 3 days, systemically poorly)

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There may be an associated effusion (glue ear). Consider a hearing assessment especially if recurrent.

Otitis Externa
This is often caused by bacteria and fungi, and less commonly viruses. The ear canal is swollen and sore with discharge- like a pimple. If there's mucous there, the discharge is probably from AOM. Treat with drops - antiseptic (acetic acid) and antibiotic (ciprofloxacin or aminoglycoside if no TM rupture).

Malignant Otitis Externa
Very painful and often in the elderly. Caused by pseudomonas.

Foreign Bodies in the Ear
Read this RCEMLearning article.

Nose Trauma
Nose trauma is common in children. There is a belief that nasal septal haematomas are more common - look for a cherry red haematoma in the nose.

https://www.rcemlearning.co.uk/foamed/stuck-in-the-ear/
https://journalfeed.org/article-a-day/2017/wait-and-see-antibiotics-for-otitis-media
https://dontforgetthebubbles.com/otitis-media/
https://www.nice.org.uk/guidance/ng91
https://www.rcemlearning.co.uk/foamed/stuck-in-the-ear/
https://www.gpnotebook.co.uk/simplepage.cfm?ID=-1241120761
http://dontforgetthebubbles.com/otitis-externa/
https://emedicine.medscape.com/article/845525-overview
https://www.bmj.com/content/349/bmj.g6075

Auricular Haematoma

Drainage of an auricular haematoma is one of the "new" practical procedures that has popped up on our e-portfolio. This is difficult to get signed off because there are minimal resources on it, and it's not a skill I've ever seen performed in the ED. I'm not sure if it's because I'm missing them, and not looking hard enough for them, or if it quite simply isn't a procedure we do in the ED. I've seen ear lacs and swollen ears - I must be missing something.

What is An Auricular Haematoma?
An auricular haematoma is a collection of blood that forms between the cartilage and the perichondrium of the ear. It is most often caused by blunt trauma to the ear.

Initial Treatment
Needle aspiration is often recommended. This failed in 75% of cases - maybe because the needle itself introduces haematoma.

Incision and Drainage
Incise along an anatomic crease to avoid a scar. Use forceps to encourage all of the haematoma out. Put a drain in, and then a dressing for compression. Prophylactic antibiotics have no evidence.

https://www.ebmedicine.net/topics.php?paction=showTopic&topic_id=228
http://lifeinthefastlane.com/common-ear-complaints-in-the-ed/
http://journals.lww.com/em-news/Fulltext/2006/04000/Diagnosis__Traumatic_Auricular_Hematoma.20.aspx
http://www.epmonthly.com/departments/clinical-skills/visual-dx/how-to-treat-an-auricular-hematoma-in-the-emergency-department-photo-guide/