A 10-year-old female reports ear pain that has worsened during the past three days. Fever and discharge from the ear are not observed. A good appetite is present. The patient does not provide a clear description of pain except stating that it is of a reproducible character. Still, the decision to take baby aspirin to relieve the pain was made and proved that the patient suffered from severe for her age pain. In the past year, she used an oral antibiotic to deal with her otitis media. She also takes an asthma inhaler regularly.
Regarding the past medical history of recurrent otitis media, seasonal allergies, and the fact that she took swimming activities in her summer camp regularly, it is possible to say that the patient has otitis externa. As an ARNP, I should proceed with the case through the evaluation of the current condition of the patient, their awareness about recurrent diseases, and define the level of parental involvement in this family. This case will be based on the overview of otitis media and treatment options for a school-aged patient.
Otitis externa is a type of inflammation that is usually characterized by the presence of infection in the external auditory canal or the auricle. Ear canals are red and swollen, and discharge may be present but not always (Hoberman et al., 2016). Otitis externa is also known as swimmer’s ear because it is caused by such bacteria as Staphylococcus epidermis and Pseudomonas aeruginosa that are usually found in water (Gore, 2018).
A virus may also cause this type of otitis. Still, these cases are rare. In addition to fever and pain, the main symptoms of this disease are itching, redness, and a feeling of discomfort. Symptoms onset is about 48 hours (Gore, 2018). Clinical diagnosis is based on the patient’s history and physical examination. It is important to find out if the patient has recently got any traumas or tried some unusual practices that may influence the ears.
The main goal of treatment for a child is to reduce the level of pain and find a true cause of her worsened condition. Antimicrobial resistance can be a problem for many children (Hoberman et al., 2016). Therefore, the aim of treatment is not to overuse antibiotics but to make sure the patient deals with pain independently. Regarding the clinical practice guidelines developed by Rosenfeld et al. (2014), a treatment plan should include an appropriate aural toilet, antiseptic and antibiotic drops, oral antibiotics, and analgesics.
Ofloxacin 0.3% should be given once daily to fight the bacteria, and hydrocortisone 1.0% to deal with the infection and reduce the redness should be taken 3 times daily (Rosenfeld et al., 2014). Hydrocortisone may also be in the form of a cream (1 g). The choice of antibiotics depends on such factors as the patient’s allergies and resistance. Two weeks is the required treatment period.
Blurred vision, anxiety, dizziness, and dry mouth may bother patients of different groups. Sometimes, young patients experience a headache and heartbeats.
- Drug-drug – The combination of the chosen drugs is not characterized by some negative outcomes. Doctors support the idea of using this antibiotic and a steroid to deal with the complications of external otitis.
- Drug-food: No negative reactions to the chosen medications are observed in terms of taking food.
If Ofloxacin-Hydrocortisone therapy does not work, it is possible to change the types of steroids and antibiotics first. Then, to achieve better results, the ear should be checked for fungus in order to choose another form of therapy. The patients from other age groups can follow the same prescriptions as a part of primary or alternative care.
Recurrent problems with ears are not usually connected with a family history of allergies. Still, the style of life the patient prefers and the activities she likes to be involved in having to be identified and discussed in order to remove those which may cause harm or complications. Regarding the therapy and personal information of the patient, her care plan has to be individualized and controlled by a parent.
Side effects, including dizziness and headaches, can change the patient’s condition and mood (Rosenfeld et al., 2014). Therefore, her mother should make regular observations and support the activities where swimming and water are not included. The patient should also be explained that regular visits to a local otolaryngologist can help to prevent complications and repeated ear problems and pain.
Over-the-Counter and/or alternative medications or therapies
Preventive therapy for a patient who has recurrent otitis media should be based on lifestyle changes, attention to hygiene, and prophylaxis with oils, ginger, or garlic (the last two are effective due to their anti-inflammatory characteristics). Communication with parents about an earache should begin as soon as it starts bothering. Neither cold nor hot compresses should be taken unless the doctor’s examination and recommendation.
Dietary/Life Style Recommendations
Though it is hard for a young girl to avoid swimming activities in a summer camp, it is possible at least to try to protect her ears and use special protective means. There are special swimming caps, earplugs, and drops that may protect the child during swimming. Diet has nothing in common with the management of an earache.
Gore, J. (2018). Otitis externa. Journal of the American Academy of Physical Assistants, 31(2), 47-48.
Hoberman, A., Paradise, J. L., Rockette, H. E., Kearney, D. H., Bhatnagar, S., Shope, T. R.,… Block, S. L. (2016). Shortened antimicrobial treatment for acute otitis media in young children. New England Journal of Medicine, 375(25), 2446-2456.
Rosenfeld, R. M., Schwartz, S. R., Cannon, C. R., Roland, P. S., Simon, G. R., Kumar, K. A.,… Robertson, P. J. (2014). Clinical practice guideline: Acute otitis externa. Otolaryngology – Head and Neck Surgery, 150(1), 1-24.