Patient History and Physical Exam Roles
The middle-aged male patient presents with pain in his left ear, the onset of which happened the night before the examination. The patient reports that he has type II diabetes mellitus, hyperlipidemia, and hypertension, all of which are controlled medically. The identified medical history allows considering the existing diseases while diagnosing and preparing treatment options. It would also be useful if the patient could provide family history, identify living conditions, and provide any other relevant information. In particular, Buttaro, Trybulski, Polgar Bailey, and Sandberg-Cook (2017) note that people living in the areas with increased humidity are more likely to suffer from ear disorders, especially acute otitis externa. The evidence also emphasizes that physical examination is critical to reveal the symptoms and identify differential diagnoses (Buttaro et al., 2017).
Primary Diagnosis and Differential Diagnoses
- Acute otitis externa (AOE). Specified as the primary diagnosis for the given patient, AOE presents the external auditory canal cellulitis caused by Staphylococcus aureus or Pseudomonas aeruginosa (Rosenfeld et al., 2014). The characteristic symptoms of pain, edema, tenderness, erythema, and exudates are identified in the patient. Mild hearing loss and slightly increased temperature may also be mentioned.
- Acute otitis media (AOM). It occurs due to inflammation and infection of the middle ear behind the eardrum. The eustachian tube appears to be swollen because of allergy, influenza, a sinus infection, and other similar causes (Atkinson, Wallis, & Coatesworth, 2015). The given patient denies any infections, fever, and allergy except the one in response to Amoxicillin.
- Tympanic membrane rupture. According to Jellinge, Kristensen, and Larsen (2015), at the time of injury, patients feel severe pain. The intensity of the pain syndrome is so great that they may develop a short-term fainting condition. The key causes of rupture of the membrane are the local inflammatory process, barotraumas, loud noise, and mechanical traumas. Earache was gradual in this patient, and no traumas were reported.
- Cholesteatoma. It is a tumor-shaped encapsulated middle ear formation, consisting predominantly of cells of keratinizing squamous epithelium and cholesterol crystals (Kuo, 2015). The disease may manifest in tinnitus, balance disruption, and pain in the ear, as well as a decrease in hearing and a small amount of putrefactive odor discharge from the ear.
Potential Treatment Options
If treatment has not been started on time, it can lead to serious consequences. AOE may transform into a chronic form and often recur, reducing the patient’s quality of life. It should also be stressed that the infection has the property of spreading, involving the pathological process of lymph nodes, cartilage of the auricle, and the ear (Rosenfeld et al., 2014). In this case, the systematic use of antibiotics should be prescribed.
The antibiotic therapy should start with the elimination of Amoxicillin as the treatment option since the given patient’s allergic reactions. Buttaro et al. (2017) argue that antibiotic-corticosteroid compound such as Cortisporin otic suspension (4 drops 3-4 times per day), containing neomycin and polymyxin B sulfates and hydrocortisone, may be used. It will allow reducing the intensity of the pain syndrome and inflammation. The use of a cotton wick may be required to ensure that medication achieves deeper recesses if the canal is particularly edematous (Buttaro et al., 2017). Since the patient has diabetes, he should be assigned a systemic therapy to strengthen the immunity system based on adaptogens or vitamin and mineral complexes (Rosenfeld et al., 2014). The future prevention of AOE should include avoiding hypothermia, dirty water entering the area of the ear canal, following swimming precautions, and proper ear cleaning without using cotton-tipped swabs (Rosenfeld et al., 2014).
References
Atkinson, H., Wallis, S., & Coatesworth, A. P. (2015). Acute otitis media. Postgraduate Medicine, 127(4), 386-390.
Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2017). Primary care: A collaborative practice (5th ed.). St. Louis, MO: Elsevier.
Jellinge, M. E., Kristensen, S., & Larsen, K. (2015). Spontaneous closure of traumatic tympanic membrane perforations: Observational study. The Journal of Laryngology & Otology, 129(10), 950-954.
Kuo, C. L. (2015). Etiopathogenesis of acquired cholesteatoma: Prominent theories and recent advances in biomolecular research. The Laryngoscope, 125(1), 234-240.
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), 1-24.