Emergency Medicine

NON-TRAUMATIC CONDITIONS OF THE EAR

ENT emergencies 399

2 Movement of the pinna and introduction of a speculum exacerbate the pain.
Deafness is minimal.

3 Remember to test the urine for sugar.

MANAGEMENT

1 Insert a wick soaked in 10% ichthammol in glycerin to encourage discharge
of the pus, start f lucloxacillin 500 mg orally q.d.s. and give an analgesic such
as paracetamol 500 mg and codeine phosphate 8 mg two tablets orally q.d.s.

2 Refer the patient to the ENT clinic for follow-up.

Acute otitis media

DIAGNOSIS

1 This is common in children, due to viral or bacterial infection such as
pneumococcus, Moraxella catarrhalis or Haemophilus inf luenzae, which is
now rapidly decreasing in children under 6 years with HiB immunization.

2 There is intense earache, variable fever, conductive deafness, and on exami-
nation of the eardrum in the early stages there is loss of the light ref lex and
injected vessels are seen around the malleus.

3 As the infection progresses, a bulging, immobile drum is seen, which may
perforate, discharging pus.

MANAGEMENT

1 Most cases settle spontaneously with regular analgesia such as paracetamol
15 mg/kg orally q.d.s. or ibuprofen 10 mg/kg orally t.d.s.

2 The role of antibiotics is contentious. If systemically unwell with fever and
vomiting, or no better by 48 h give amoxycillin 250–500 mg orally t.d.s. for 5
days with the analgesia.
(i) Give cefaclor 125–250 mg orally t.d.s. for 5 days if the patient is
allergic to penicillin.

Mastoiditis

DIAGNOSIS AND MANAGEMENT

1 There is extension of infection from acute otitis media into the mastoid
air-cell system.

2 The patient is ill and feverish, with local redness and tenderness over the
mastoid, and the pinna is pushed down and forwards.

3 Complications include cranial nerve palsy, meningitis and subperiosteal
abscess.

4 Refer the patient immediately to the ENT team for X-ray, CT scan and
parenteral antibiotics.