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Further Questions to Ask

Are you having any issues with you balance?

Do you have the sensation to itch your inner ear?

Have you had any drainage from your ear?

Have you noticed any changes in your hearing?

(Harvard Health Publishing, 2020).

Time Course and Different Causes of Ear Pain

Acute otitis externa is usually associated with simmer’s ear and occurs with a gradual onset over the course of 2-3 days after swimming (Center for Disease Control and Prevention, 2020). Acute otitis media may occur shortly after an upper respiratory infection and are usually symptoms show at day 3 or after (Seattle Children’s, 2020).

Age of Onset and Diagnostic Possibilities

The most common age for acute otitis media to occur is between 6 months to 2 years of age. This is due to the Eustachian tube swelling during inflammation, regurgitation or infection, leaving little room for drainage (Seattle Children’s, 2020). Although swimmers ear can occur in all ages, it normally occurs in older children, adolescents and adults rather than infants and toddlers.

Diagnostic[GS1] Tests and Differential Diagnosis

Diagnosis

Diagnostic Tests

Pharmacological Treatment

Acute Otitis Media

Although diagnostic tests are rarely needed, pneumatic otoscopy may show decrease or absent tympanic membrane mobility.

NSAID- 325-650 PO Q 4 hours PRN pain.

1st Generation

Keflex (cephalosporin) 250-500 mg PO QID or

Dicloxacillin (penicillin) 250

(Keflex) 250 to 500 mg PO 4 QID

2nd Generation

Omnicef (cephalosporin) 300 mg PO BID or

Augmenting XR (penicillin) 1000 mg PO BID

Fluoroquinolones

Cipro 500mg PO BID or

Ceftazidim 2 g IV Q 8-12 hours

Acute Otitis Externa

Although diagnostic test are rarely needed, fluid from the ear may be cultured and bacteria can be detected and tested for antibiotic sensitivity.

Perforated Tympanic Membrane

Ciprolfoxacin 0.3% & dexamethasone 0.1 % (Ciprodex oti). +6 months 4 gtts to affect ear BID for 7 days.

Non-Perforated Tympanic Membrane

Ciprofloxacin 0.2% & Hydrocortisone 1% (Cipro HC otic) 1yr+ 3 gtts to affected ear BID for 7 days

Colistin 3mg, neomycin 3.3 mg hydrocortisone acetate 10 mg, thonzonium bromide 0.5 mg (Cortisporin- TC otic).

Adutls: 4 gtts to affected ear TID for 7 days

TMJ (Trigeminal Neuralgia)

Neurological assessment that tests facial nerve reflexes can be performed and an MRI may detect multiple sclerosis or any tumor that may be the cause of TMJ.

Anticonvulsants (Tegretol, Carbatrol, others)

Antispasmodic agents (Gablofen & Lioresal)

Botox injections (onabotulinumtoxin A)

(Dunphy et al, 2015) & (National Organization for Rare Disorders, Inc.,2020).

References

Center for Disease Control and Prevention. (2020). Facts about swimmer’s ear.

Retrieved from https://www.cdc.gov/healthywater/pdf/

swimming/resources/pseudomonas-factsheet_swimmers_ear.pdf on 18 January 2020.

Dunphy, L., Windland-Brown, J., Porter, B., Thomas, D. (2015). Primary care: Art and

Science of Advanced Practice Nursing (4th ed.). Philadelphia. F.A. Davis.

Harvard Health Publishing. (2020). Retrieved from https://www.health.harvard.edu/a

_to_z/swimmers-ear-otitis-externa-a-to-z on 18 January 2020.

National Organization for Rare Disorders, Inc. (2020). Trigeminal Neuralgia. Retrieved

from https://rarediseases.org/rare-diseases/trigeminal-… / on 18 January 2020.

Seattle Children’s. (2020). Ear infection questions. Retrieved from

https://www.seattlechildrens.org/conditions/a-z/ea… on 18 January 2020.

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