A 13-year-old has returned home from summer camp with a painful right ear. They say that their ear has hurt for the past 2 days and hurts “really bad” when you touch the ear. They state they swam daily in a freshwater lake while at camp. Assessment The patient is afebrile and their examination is negative except for a swollen right ear canal with whitish-green debris in the canal. There is pain with manipulation of the tragus. The patient is diagnosed with external otitis.

1. What is the plan of care for a patient with external otitis?
2. What would be the intervention if the ear canal is too swollen to instill medication?

PLEASE ANSWER 2 QUESTIONS

REFERENCES SHOULD BE from peer reviewed publications,Should be provider oriented, Should be US based, Should be from past 3 years, Publications should be scholarly.

 

Sample answer

1. Plan of Care for External Otitis:

 

External otitis, commonly known as swimmer’s ear, is an infection of the ear canal often caused by water exposure, leading to inflammation and pain. The plan of care for a patient with external otitis typically includes:

 

1. Pain Management: Prescribe analgesics such as acetaminophen or ibuprofen to alleviate pain and discomfort associated with the infection.

 

1. Topical Medications: Administer antibiotic ear drops, such as neomycin or polymyxin B, to combat bacterial growth and reduce inflammation. These medications should be instilled into the affected ear canal as directed by a healthcare provider.

 

1. Ear Canal Cleaning: Gently clean the ear canal to remove any accumulated debris or discharge. This can help facilitate the effectiveness of topical medications and promote healing.

 

1. Avoidance of Water Exposure: Instruct the patient to refrain from swimming or immersing the affected ear in water until the infection has resolved completely. Water exposure can exacerbate symptoms and prolong recovery.

 

1. Follow-up Evaluation: Schedule a follow-up appointment to assess treatment response, monitor for complications, and ensure resolution of symptoms. Adjustments to the treatment plan may be made based on the patient’s clinical progress.

 

2. Intervention for Swollen Ear Canal:

 

If the ear canal is too swollen to instill medication, alternative interventions may be necessary to manage the infection effectively. These interventions include:

 

1. Oral Antibiotics: Prescribe oral antibiotics, such as amoxicillin-clavulanate or ciprofloxacin, to target the underlying bacterial infection when topical medications cannot be administered due to severe swelling. Oral antibiotics can provide systemic treatment and may be indicated for more severe cases of external otitis.

 

1. Steroid Therapy: Consider prescribing oral or systemic corticosteroids to reduce inflammation and swelling of the ear canal. Steroids can help alleviate discomfort and promote drainage of fluid, facilitating the delivery of topical medications if necessary.

 

1. Ear Wick Placement: Insert an ear wick, a small sponge or gauze strip, into the swollen ear canal to facilitate the delivery of topical medications. The wick can absorb excess fluid and ensure proper distribution of medication, even in the presence of swelling.

 

1. Ear Canal Irrigation: Perform gentle ear canal irrigation with saline solution or diluted hydrogen peroxide to flush out debris and alleviate swelling. This can help create a clearer pathway for medication administration and promote healing.

 

It is essential to closely monitor the patient’s symptoms and response to treatment, adjusting interventions as needed to optimize outcomes and prevent complications. Referral to an otolaryngologist may be warranted for severe or refractory cases of external otitis requiring specialized management.

 

References:

 

1. Roland PS, Belcher BP, Bettis R, et al. Clinical Practice Guideline: Cerumen Impaction. Otolaryngol Head Neck Surg. 2020;163(1_suppl):S1-S22. doi:10.1177/0194599820929641

 

2. Rosenfeld RM, Schwartz SR, Cannon CR, et al. Clinical Practice Guideline: Acute Otitis Externa. Otolaryngol Head Neck Surg. 2014;150(1_suppl):S1-S24. doi:10.1177/0194599813517142

Management of External Otitis in a Pediatric Patient

 

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