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Earache

  • Common ddx

    • otitis media (bulging or fluid in tympanic membrane)
    • otitis externa (pain on ear tugging)
    • cerumen impaction
    • TMJ syndrome (associated with chewing)
  • Serious ddx

    • mastoiditis (mastoid tenderness)
    • herpes zoster
  • Labs

    • ear exam
    • culture and sensitivity if discharge
    • throat swab if sore throat
    • CT if head trauma
    • ENT consult
  • Other ddx

    • cholesteatoma, cervical osteoarthritis
  • HPI

    • onset
    • triggering event
    • location: outside or inside canal
    • severity
    • pain with chewing, neck motion
  • ROS

    • fever, rash, trauma
    • hearing loss, vertigo, tinnitus
  • PMH

    • ear wax problems
    • otitis media or externa
  • FH

  • SH

  • Meds

  • Allergies

  • Px

    • vitals
    • gen impression
    • head trauma, nystagmus
    • inspection: injury, erythema, discharge, facial rash, conjunctivitis
    • palpation: pain with tugging, mastoid tenderness
    • otoscope: tympanic membrane, cholesteatoma
    • TMJ test
    • pain with neck motion
    • lymphadenopathy
    • cardio, pulm, abd
    • gait
  • Tx

    • otitis media: amoxicillin 90mg/kg/day vs. observation if really mild
    • otitis externa: clean out canal, give ear drops (cortisporin)

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