Patient with Otitis Externa

ZM is an 8-year-old male who is brought to the clinic by his mother for complaints of acute left ear pain. She has recently picked him up from a week-long stay at camp, and he stated his ear hurt so bad he was crying. When his mother looked at this ear, she noticed the outside canal was very swollen. He could not even touch his ear. His mother states: “He is never sick, and he never cries.”

Past Medical History

• All immunizations current

• No history of surgeries

• No history of allergies

• No history of significant illness


• Multivitamin, daily

• Occasional allergy medication with children’s loratadine

Physical Examination

• Pulse: 100; respiration rate: 22; temperature: 100.2 °F data scan

• Left ear canal swollen; unable to access with otoscope to observe tympanic membrane

• Swelling noted in lymph nodes below ear

• Ear is red and warm to touch


• External otitis

Discussion Questions

1. What factors in ZM’s recent history should the clinician consider, and what additional questions should the clinician ask the mother?

2. What treatment options are indicated for ZM?

3. What patient teaching should the clinician provide?

  • Rosser, E. J. (2004). Causes of otitis externa. Veterinary Clinics: Small Animal Practice34(2), 459-468.
  • Sood, S., Strachan, D. R., Tsikoudas, A., & Stables, G. I. (2002). Allergic otitis externa. Clinical Otolaryngology & Allied Sciences27(4), 233-236.
  • Chang, P. C., Fischbein, N. J., & Holliday, R. A. (2003). Central skull base osteomyelitis in patients without otitis externa: imaging findings. American Journal of Neuroradiology24(7), 1310-1316.

Eye Conditions

AM is a 22-year-old man presenting to the local emergency department (ED) with acute onset

of right eye pain. The pain started 6 hours prior and has not improved with artificial tears or oral

acetaminophen. He reports the possibility of accidentally “scratching his right eye” when trying

to remove his contact lens.

Past Medical History

• Wears soft contact lenses, replaces monthly

• Denies swimming or showering in contacts

• Occasionally sleeps in contacts

Physical Examination

• Visual acuity: right eye, 20/40; left eye, 20/20

• Right eye is diffusely injected, small pinpoint area of haze is noted in the periphery at 6 o’clock; region subsequently stains with fluorescein

Discussion Questions

1. What is the appropriate pharmacologic treatment for AM?

2. What is the appropriate follow up for AM?

3. How should AM be counseled regarding his contact lens