Emergency Medicine

Non-traumatic Conditions of the Ear

398 ENT emergencies

5 Remember that basal skull fracture can be a clinical diagnosis, if X-rays have

to wait until the patient is stable and other injuries to the head, neck and

chest have been assessed f ully.

(i) Request an immediate CT head scan once the patient has been

stabilized.

MANAGEMENT

1 Admit the patient under the surgical team for head injury care and advice

from the neurosurgical unit or ENT specialist.

NON-TRAUMATIC CONDITIONS OF THE EAR

All these conditions present with pain and/or hearing loss.

Otitis externa

DIAGNOSIS

1 A bacterial or fungal infection is usually responsible, often following

repeated use of cotton-wool buds, or exposure to water (‘swimmer’s ear’).

2 There is extreme pain, desquamation of skin, and on otoscopy an oedema-

tous, narrowed ear canal, often containing debris and discharge.

MANAGEMENT

1 Attempt aural toilet using a cotton wick or fine aspiration tube on suction to

gently remove the debris, although pain may preclude this.

2 Insert a Merocel™ wick to maintain externa l ear cana l patency.

(i) Add a proprietary anti-infective and steroid preparation such

as Kenacomb Otic™, Sofradex™ or Locorten- Vioform™ three

drops two to four times daily into the external auditory canal,

and onto the wick.

3 Refer the patient to the ENT clinic for formal aural toilet.

4 Refer the patient directly to the ENT team if the otitis externa is severe with

painful occlusion of the external ear canal.

Furunculosis of the external ear

DIAGNOSIS

1 A furuncle may develop in the outer part of the external auditory canal

causing extreme pain.