What tests should a patient with recurrent otitis media (ear infections) and Benign Prostatic Hyperplasia (BPH), as well as kidney disease, undergo?

From the Guidelines

For a patient with ear infections, benign prostatic hyperplasia (BPH), and kidney disease, a comprehensive diagnostic approach is essential to manage their conditions effectively and minimize potential complications. The patient should undergo a series of tests to assess their overall health and the severity of their conditions.

• A comprehensive urinalysis and urine culture are crucial to assess kidney function and rule out urinary tract infections, as indicated by the European Association of Urology guidelines on urological infections 1.
• Blood tests, including complete blood count (CBC), comprehensive metabolic panel (CMP), prostate-specific antigen (PSA), and kidney function tests (BUN, creatinine, eGFR), are essential to evaluate the patient's kidney function, prostate health, and overall metabolic status.
• For the ear infections, an otoscopic examination and possibly a culture of ear discharge should be performed to determine the cause of the infection and guide antibiotic treatment, as suggested by the clinical practice guideline on tympanostomy tubes in children 1.
• Imaging studies, such as renal ultrasound to evaluate kidney structure and post-void residual (PVR) measurement to assess bladder emptying, are important to assess the patient's urinary tract and kidney function, as recommended by the AUA guideline on management of benign prostatic hyperplasia 1 and the AUA guideline amendment 2019 1.
• Additionally, uroflowmetry to measure urine flow rate and audiometry to evaluate hearing loss from recurrent ear infections may be beneficial to assess the patient's urinary flow and hearing status. These tests are crucial because the conditions can interact - antibiotics for ear infections may affect kidney function, while BPH medications need adjustment based on kidney status, as highlighted by the National Kidney Foundation practice guidelines for chronic kidney disease 1 and the diagnosis, evaluation, and follow-up of asymptomatic microhematuria (AMH) in adults guideline 1. The comprehensive testing approach allows for appropriate treatment planning while minimizing risks of medication interactions or worsening of existing conditions.
• The patient's kidney function should be closely monitored, and any signs of kidney disease progression should be promptly addressed, as emphasized by the European Association of Urology guidelines on urological infections 1.
• The patient's BPH symptoms should be managed with medications or surgical interventions as needed, taking into account their kidney function and overall health status, as recommended by the AUA guideline on management of benign prostatic hyperplasia 1 and the AUA guideline amendment 2019 1.
• The patient's ear infections should be treated with antibiotics or other interventions as needed, and their hearing status should be closely monitored to prevent further hearing loss, as suggested by the clinical practice guideline on tympanostomy tubes in children 1.

From the Research

Diagnostic Tests for Recurrent Otitis Media

• Tympanocentesis to obtain middle ear exudate for microbiological culture 2, 3, 4, 5
• Direct examination and culture of purulent material obtained by myringotomy after rupture of the tympanic membrane 2
• Middle ear fluid culture to determine the causative pathogen and guide antibiotic treatment 3, 4, 5, 6

Diagnostic Tests for Benign Prostatic Hyperplasia (BPH)

• No research papers provided to assist in answering this question

Diagnostic Tests for Kidney Disease

• No research papers provided to assist in answering this question

Additional Tests

• Clinical/otologic (CO) score to evaluate the severity of symptoms such as fever, irritability, and tympanic membrane redness and bulging 6
• Antibiotic susceptibility testing to determine the effectiveness of different antibiotics against the causative pathogen 3, 5