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HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

SYMPTOMS/EXAM

■ Onset within 48 hours

■ Fever, ear pain (otalgia), and otorrhea

■ Conductive hearing loss

■ Peripheral vertigo

■ Red or cloudy tympanic membrane, possible effusion

■ Bulging or retracted TM

■ Loss of TM mobility on insufflation (pneumatic otoscopy)

■ Loss of light reflex (see Figure 14.2)

TREATMENT

■ Antipyretics, analgesics, ±antibiotics

■ Some guidelines recommend delaying administration of antibiotics for

24–72 hours until patient is reassessed or reserving antibiotics for patients

with fever or vomiting.

■ Follow-up in 3–5 days

■ Recurrent OM may require ENT referral for myringotomy.

COMPLICATIONS

■ Hearing loss may affect speech and cause developmental delay.

■ Mastoiditis

■ TM perforation (most common complication)

FIGURE 14.1. Malignant otitis externa.

(Courtesy of Frank Birinyi, MD as published in Knoop KJ, Stack LB, Storrow AB. Atlas of

Emergency Medicine,2nd ed. New York: McGraw-Hill, 2002:125.)