Posted: May 14th, 2023

What factors in ZM’s recent history should the clinician consider

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Patient with Otitis Externa
ZM is an 8-year-old male who is brought to the clinic by his mother for complaints of acute left ear pain. She has recently picked him up from a week-long stay at camp, and he stated his ear hurt so bad he was crying. When his mother looked at this ear, she noticed the outside canal was very swollen. He could not even touch his ear. His mother states: “He is never sick, and he never cries.”
Past Medical History
All immunizations current
No history of surgeries
No history of allergies
No history of significant illness
Medications
Multivitamin, daily
Occasional allergy medication with children’s loratadine
Physical Examination
Pulse: 100; respiration rate: 22; temperature: 100.2 °F data scan
Left ear canal swollen; unable to access with otoscope to observe tympanic membrane
Swelling noted in lymph nodes below ear
Ear is red and warm to touch
Diagnosis
External otitis
Discussion Questions
1. What factors in ZM’s recent history should the clinician consider, and what additional questions should the clinician ask the mother?
2. What treatment options are indicated for ZM?
3. What patient teaching should the clinician provide?

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What factors in ZM’s recent history should the clinician consider, and what additional questions should the clinician ask the mother?
The clinician should consider several factors in ZM’s recent history to help with the diagnosis and treatment of his external otitis. Firstly, ZM has recently returned from a week-long stay at camp. This history could suggest exposure to various bacteria, including Pseudomonas aeruginosa, which is the most common cause of external otitis. Additionally, his past medical history is essential to identify any underlying risk factors or conditions, such as diabetes or a weakened immune system, that could lead to complications or delayed healing.

The clinician should ask the mother further questions about ZM’s symptoms, including how long the ear has been painful and if there is any discharge from the ear. The clinician should also ask if ZM had any water exposure or recent swimming, which could increase the risk of external otitis. Moreover, the clinician should inquire about any recent ear infections or injury to the ear.

What treatment options are indicated for ZM?
The treatment options for external otitis in ZM are primarily focused on pain relief and infection control. The clinician should prescribe analgesics such as acetaminophen or ibuprofen for pain management. Topical medications like acetic acid drops or antibiotics like neomycin/polymyxin/hydrocortisone (Cortisporin Otic) may be prescribed to prevent bacterial overgrowth or to manage an active bacterial infection. In severe cases, oral antibiotics may be considered. Additionally, the clinician should advise the mother to avoid water exposure to the ear until the inflammation has subsided.

What patient teaching should the clinician provide?
The clinician should provide ZM’s mother with patient teaching on preventing future episodes of external otitis. Firstly, she should avoid inserting objects like cotton swabs or hairpins into the ear canal to clean earwax, as it can cause microtrauma to the skin and predispose to infection. She should also ensure that ZM dries his ear thoroughly after bathing and swimming to prevent moisture accumulation, which can provide an ideal environment for bacterial growth. The clinician should advise the mother to avoid using earplugs or earphones that could cause skin irritation or trauma to the ear canal. Additionally, the clinician should advise ZM’s mother to seek medical attention if his symptoms persist beyond a few days, if he develops a fever, or if the pain worsens despite treatment.

In conclusion, external otitis can be a painful and debilitating condition that requires prompt diagnosis and management to prevent complications. By considering the patient’s history, prescribing appropriate medications, and providing patient education, the clinician can help ZM recover quickly and prevent future episodes of external otitis.

References:

American Academy of Otolaryngology-Head and Neck Surgery. (2019). Earwax and care. https://www.enthealth.org/conditions/earwax-and-care/.

Browning, G. G. (2018). Otitis externa: A practical guide to treatment and prevention. American Journal of Medicine, 131(10), 1186-1190.

Centers for Disease Control and Prevention. (2015). Swimmer’s ear (otitis externa). https://www.cdc.gov/healthywater/swimming/swimmers/rwi/ear-infections.html.

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