BIOSOFT HELP FILES

1)      Impacted ear wax

2)      Otitis externa – ear ache, ear discharge, yellow, yellow-green, foul smelling, itchy ear canal, deafness, eczematous ear canal, cotton bud trauma, tragus tenderness present, tugging pinna painful, tender, red ear canal, swollen canal, debris seen, finally red, tender tragus, Tx – topical antibiotics, steroid drops, NSAIDs, systemic antibiotics if cellulitis present, corticosteroid drops, analgesics,

3)      Furunculosis – severe throbbing earache, furuncle inside the ear canal, Tx - analgesics, cloxacillin

4)      Acute Otitis Media – rhinorrhea, cough, earache, irritability, ear tugging, deafness, preceding viral URTI, bulging, red TM, perforated TM with purulent discharge, Tx – paracetamol, ibuprofen, antibiotic prescription SOS if the symptoms worsen, antibiotics may be used from the start if child < 2 yrs, bilateral disease, high temperature, purulent ear discharge

5)      Traumatic perforation – ear trauma, tinnitus, ear pain, otoscopy – ear perforation and mild bleeding, Tx – no ear drops, no swimming, review 2 weeks for healing or earlier of new symptoms develop,

6)      Referred dental pain – dental infections

7)      Temporomandibular joint dysfunction – ear ache, tmj clicks, pain increase with mouth movements,

8)      Barotrauma – altitude changes as in flying, scuba diving, driving in mountains, recurrent allergies, URTIs, earache, deafness, the sensation of fullness or stuffiness in ears, dizziness, nose bleeds, ear bleeds, eardrum bulge, ear drum retraction, ruptured ear drum, blood inside the middle ear, hearing loss, vertigo, Mx – suck on candy, chew gum, etc if outside pressure is decreasing as in plane climb-ups, inhale and then exhale into the closed nostrils when outside pressure is rising as in diving and plane landing, Xylometazoline nasal decongestants, Cetirizine or Loratadine.

9)      Foreign body – contact with object, earache, dizziness, deafness, tinnitus, ea bleeding, Mx – removal only under direct vision, if not ENT referral, if live insect under otoscopy put in olive oil or if no perforations ear syringing,

10)  Perforated ear drum – acoustic trauma, barotrauma, direct self-injury, foreign bodies, ear infections, earache, ear discharge, deafness, tinnitus, Otoscopy – ear perforation seen, Mx – antibiotics, NSAIDs, usually heals within 2 months, if not tympanoplasty to prevent permanent hearing loss, recurrent otitis media

11)  TemporoMandibular Joint Syndrome – habitual clenching and teeth grinding, bruxism, poor posture like looking at computer screens with head thrust forward, myofascial pain syndrome, headache, toothache, earache, jaw pain, facial pain, jaw clicks, chewing pain, unable to open or close mouth fully, jaw deviations, tender TMJ joint, trigger points in masseters, temporalis muscles, trapezius, neck muscles, sternocleidomastoids, Mx – Massaging (look for trigger points in above muscles, massage the point with hard, slow, short strokes until the tender point disappears), attend to the risk factors above, 

1)      Otitis Externa – Topical antibiotic drops or if severe infection oral cloxacillin for 7 days or erythromycin if penicillin allergic (National Guideline Clearing House – Use of Antibiotics in Pediatric Care)

2)      Acute Otitis Media – Tx Amoxycillin 50 mg/kg/day divided doses 8 hourly for 7 days.  If no response 72 hrs later use high doses of amoxycillin+clavulanate (amoxicillin 50 mg/kg/day + clavulanate 7 mg/kg/day  in divided doses 12 hourly for 7-10 days) OR cefuroxime 15-30 mg /kg/day in divided doses 12 hrly, and if penicillin allergic erythromycin (50 mg/kg/day in divided doses 6-8 hourly for 10 days) or cotrimoxazole (Trimethoprim 8 mg/kg/day plus Sulphamethoxazole 40 mg/kg/day in divided doses 12 hourly  for 7-8 hrs) 

1)      Unilateral unexplained head and neck area pain > 1/12 associated with earache but normal otoscopy

2)      Mastoid swelling, tenderness (malignant otitis externa)

3)      Diabetes, immunocompromise (malignant otitis externa)

4)      Earache and cranial neuropathy (malignant otitis externa)

5)      Persistence and/or relapse of otitis externa symptoms

6)      Acute otitis media with facial nerve palsy (Acute mastoiditis)

7)      Acute otitis media with mastoid signs (like swelling, edema, redness and tenderness, anterior inferior displacement of the ear, high spiking fevers)(Emergency ENT referral)

1)      Ear discharge – purulent and offensive (exclude foreign body)

2)      Hearing loss – (exclude wax then refer if deafness confirmed)

(NCC-PC Referral Guidelines for Suspected Cancer  in Adults and Children)

(National Guideline Clearing House – Use of Antibiotics in Pediatric Care)

1)      Otitis externa

2)      Otitis media

3)      Ear trauma

1)      Ear discharge, foul smelling, occasionally blood stained, recurrent purulent ear discharge, slow onset and progressive deafness, recurrent ear infections in the past - Cholesteatoma

(Holt 2003)

1)      Pedal edema, bruising, arthralgias or joint swelling, mucosal changes in a patient with GIT disease, poor dentition, food faddism, alcoholism – exclude vitamin C deficiency

(Olmedo et.al. 2006)