|Type of paper:||Research paper|
Acute Otitis Externa (AOE)
The rapid onset of the symptoms within 48 hours accompanied by severe otalgia and hearing loss (Hui, 2013). The history of diabetes mellitus also exposes the patient to the possibilities of acquiring acute otitis externa.
Otitis Media (OM)
Otitis Media diagnosis is informed by the patient's swelling on the left side of the face. The swelling depicts potential bulging of the tympanic membrane. The onset of otorrhea may have caused the bulginotorrheag as a result of Otitis Externa or the pain the patient has been experiencing in the past 48 hours. The slight hearing loss may also be as a result of otitis media with effusion which causes the ear to fill with fluid.
Blockage of the ear from listening may be as a result of a foreign body stuck in the ear canal. The foreign object may cause immense discomfort and pain if not removed. The object also blocks hearing and results in swelling.
The blockage of the ear accompanied with pain, hearing loss and swelling may be caused by sloughed epithelial cells, hair and secretions coming from the external auditory canal (Daniel, Ursulla & Pollart, 2007). Accumulation of cerumen in the ear of the patient may be as a result of cardiac depression as the patient has a history of hypertension and hyperlipidemia. Cardiac accompanies stimulation of the ear canal from cerumen removal attempts resulting in accumulation (Daniel, Ursulla & Pollart, 2007). The condition is also common among middle-aged (>50) men.
Role Played By Patient History and Physical Exam
The patient history helped in determining the ideal medication that is not likely to trigger the patient's allergies. Also, the patient's medical history informed of the underlying conditions that increase his chances of acquiring infections such as cerumen impaction.
The physical exam depicted the general status of the patient's health. For example, the patients heightened blood pressure guides the kind of treatment that is required - identification of medicines currently prescribed helped in analyzing possible interactions that may trigger infections.
Potential Treatment Options
Acute Otitis Externa (AOE)
Otalgia depicts the case should be managed through ophthalmic preparations is the preferred treatment method due to the low pH facilitating compliance with treatment recommendations. Antimicrobial agents such as aminoglycosides or acetic acid preferred to quinolone antibiotics due to the patient's allergy to Amoxicillin. If the ear canal is not visible, then an expandable wick can be used to reduce the canal edema and ease topical medical delivery (Hui, 2013).
Otitis Media (OM)
Otitis Media can be treated using trimethoprim-sulfamethoxazole. If the condition becomes severe, the patient can be treated by aeration of the middle ear and also using vasoconstrictor drugs. If there are possibilities for a secondary infection, then antibiotics are used.
The treatment depends on the location and the type of object involved. Removal of the foreign object has to be done gently and with care as struggling increases the chances of complications (Buccino, Plantz, Talavera and Taylor, 2018). The following are some of the commonly used techniques.
Applying a moderate suction to the object using small instruments with a loop or hook at the tip such as forceps.
If the eardrum is intact, then warm water may be gently sprayed past the object with the help of a small tube. The water then turns around at the end of the canal and washes the foreign object out.
For metallic objects, a magnetized instrument may be used to slowly pull the object from the ear (Buccino, Plantz, Talavera and Taylor, 2018)
The current treatment procedures entail by irrigation or manual cleaning of the external auditory canal. Manual treatment can be done using curette, suction or forceps (Daniel, Ursulla & Pollart, 2007). During the manual procedure, care should be taken to avoid extreme pain as the patients Systolic Pressure is at Prehypertension state (from 120-139). Irrigation of the can, on the other hand, can be done with or without ceruminolytics. The use of ceruminolytics such as Docusate sodium or 10% Triethanolamine polypeptide oleate-condensate increases the success rate of irrigation (Daniel, Ursulla & Pollart, 2007). The method should also be conducted using ear irrigator tip as it eliminates pressure build-up and prevents the water from hitting the, therefore, minimizing the possibilities of tympanic membrane perforation.
Buccino, K., Plantz S. H., Talavera, F. & Taylor, J. (2018). Foreign Body in Ear. E-medicine health. Retrieved from https://www.emedicinehealth.com/foreign_body_ear/article_em.htm#how_do_you_remove_an_object_stuck_in_your_ear
Daniel F.M., A. Ursulla C., & Pollart, S.M., (2007). Cerumen Impaction. American Family Physician 15; 75(10):1523-1528. Retrieved from https://www.aafp.org/afp/2007/0515/p1523.html
Hui C. P.S (2013). Acute otitis externa. Journal of Paediatr Child Health v.18 (2); 2013 FebPMC3567906. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3567906/References
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