Otitis Externa Case Study
Case Study 3
In case study 3 a middle-aged male came to the office complaining of a left earache of two days. The onset has been slow but increasing steadily. Constant pain, diminished hearing loss, some swelling to the left side of face, tenderness of left pinna and periauricular area, drainage (no color given), and an invisible TM. The patient denies having symptoms of chills, fever, and upper respiratory infection which will assist greatly with the differential diagnosis.
The History and Physical Assessment
The history of the current illness plays a key part in the continuum of the physical assessment (Campbell & Lynn, 2017). In case 3, the patient has presented with a medical history of Type 2 diabetes mellitus, hypertension, and hyperlipidemia.
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These set of symptoms led me to diagnose the patient to have otitis externa with transient otitis media with effusion (OME). Since the management of otitis externa should focus on clearing any debris from the canal, addressing the pain, and alleviate the inflammation and infection (Buttaro et al., 2013).
To alleviate the pain, I would order an analgesic or narcotic according to the severity of the pain. Next, I would clear any debris in the ear canal that could hinder healing while being careful not to introduce anything sharp into the ear canal. Then I would order a topical antibiotic to repair the redness and inflammation of the external ear. I would also order a systemic antibiotic because the patient is a diabetic. Fluoroquinolones are very effective in treating both P. aeruginosa and S. aureus (Buttaro et al., 2013), but one of the most serious side effects of fluoroquinolones is irreversible peripheral neuropathy. Because the patient is a diabetic and prone to peripheral neuropathy, I would order instead an aminoglycoside, Neomycin with polymysin B that will cover both P. aeruginosa and S. aureus as well. Moreover, if the patient 's hearing loss does not return to normal, I would refer the patient to an otolaryngologist for further evaluation of possible perforated tympanic
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