From the Guidelines
The best course of treatment for this 50-year-old male patient with a history of acute otitis media and recent mastoiditis surgery, presenting with right ear pain, particularly when lying down, after a tube was reportedly pulled out from his ear, is a prompt evaluation by an otolaryngologist (ENT specialist) and pain management with ibuprofen 400-600 mg every 6-8 hours as needed. The patient's history of mastoiditis and recent surgery suggests a high risk of complications, and the premature removal of the ventilation tube may have led to middle ear inflammation or pressure changes, causing the ear pain when lying down. According to the clinical practice guideline for acute otitis externa 1, pain medicine is especially important to use for relief in the first few days, until the eardrops begin working, and the patient should discuss with the doctor which pain medicines are best for them. Key considerations for the ENT specialist include:
- Evaluating the patient for signs of infection or other complications
- Prescribing antibiotic ear drops if necessary, such as ofloxacin 0.3% (5 drops twice daily for 7 days)
- Advising the patient on how to manage pain and prevent further complications, such as avoiding getting water in the affected ear
- Monitoring the patient closely to prevent recurrence or complications such as hearing loss or spread of infection. It is essential to note that the patient should inform the doctor about any prior ear surgery, opening (hole or perforation) of the eardrum, or ear tube in place, as this may affect the choice of eardrop or management plan 1.
From the Research
Patient Presentation and History
- The patient is a 50-year-old male with a history of acute otitis media and recent mastoiditis surgery, presenting with right ear pain, particularly when lying down.
- The patient reports that a tube was pulled out from his ear by a doctor in county jail after his surgery.
Possible Causes of Ear Pain
- Primary otalgia, which originates from the ear, with common causes including otitis media and otitis externa 2, 3.
- Secondary otalgia, which originates outside the ear, with common causes including temporomandibular joint syndrome, pharyngitis, dental disease, and cervical spine arthritis 2, 3.
Diagnostic Approach
- History and physical examination are crucial in determining the underlying cause of ear pain 2, 3.
- If the diagnosis is not immediately clear, a trial of symptomatic treatment, imaging studies, and consultation with an otolaryngologist may be reasonable options 2, 3.
Treatment Considerations
- The patient's age (50 years or older) and history of smoking or alcohol use may increase the risk of a serious occult cause of ear pain, warranting further evaluation 2, 3.
- Symptomatic treatment with ibuprofen for pain may be appropriate, but further evaluation and consultation with an otolaryngologist are recommended to determine the underlying cause of ear pain.
- Antibiotic prophylaxis in clean and clean-contaminated ear surgery may not be necessary, as there is no strong evidence that it reduces postoperative complications such as wound infection, discharge from the outer ear canal, labyrinthitis, and graft failure 4.