From the Guidelines
When taking a history for ear ache, it is crucial to focus on the onset, duration, severity, and character of the pain, as well as associated symptoms like hearing loss, discharge, fever, dizziness, or tinnitus, to differentiate between various conditions such as acute otitis media (AOM), otitis media with effusion (OME), and chronic suppurative otitis media (CSOM) 1.
Key aspects to cover in the history include:
- Onset and duration of the ear pain
- Severity and character of the pain
- Associated symptoms such as hearing loss, discharge, fever, dizziness, or tinnitus
- Recent upper respiratory infections, which can ascend through the Eustachian tube to the middle ear and pave the way for bacterial otopathogens 1
- History of swimming, trauma, or foreign body insertion
- Previous ear problems, treatments tried, and response to those treatments
- For children, signs like pulling at ears, irritability, or sleep disturbances
- Medical history, including conditions like diabetes or immune disorders, which can impact the risk and management of ear infections
- Recent air travel, which can cause changes in ear pressure
- Family history of ear problems, which may indicate a genetic predisposition
Understanding these factors is essential for distinguishing between common causes of ear ache, such as AOM, otitis externa, or referred pain from dental or TMJ issues, and for planning appropriate diagnosis and treatment, whether it involves antibiotics for bacterial infections, analgesics for pain management, or referral to specialists for complex cases, ultimately aiming to prevent complications like hearing loss and improve quality of life 1.
From the Research
Important History for Ear Ache
- Ear ache, also known as otalgia, is a common presentation in primary care settings with diverse causes 2.
- The history of ear ache can be categorized into primary otalgia, which originates from the ear, and secondary otalgia, which originates from outside the ear 2.
- Primary otalgia is more common in children, while secondary otalgia is more common in adults 2.
- The most common causes of primary otalgia include otitis media and otitis externa, while the most common causes of secondary otalgia include temporomandibular joint syndrome and dental infections 2.
- A thorough history and physical examination are essential in establishing the underlying cause of ear ache, and may lead to the diagnosis of serious conditions such as temporal arteritis and malignant neoplasms 2.
- Upper respiratory tract infections (URTIs) are a common cause of ear ache, and can lead to complications such as acute otitis media (AOM) 3, 4.
- AOM can present with a range of symptoms, including ear pain, fever, and hearing loss, and can be managed with watchful waiting or antibiotics depending on the severity of the infection 3, 4.
- The clinical spectrum of AOM can vary widely, and understanding this spectrum is essential in developing treatment criteria that minimize antibiotic use 4.
- An evidence-based approach to the evaluation of patients with ear ache, sore throat, and sinusitis is essential in establishing an accurate diagnosis and developing an effective treatment plan 5.