A 57-Year-Old Man with Pulsing Pain and Left Ear Drainage

ANSWER

Case Study: A 57-Year-Old Man with Pulsing Pain and Left Ear Drainage
1. Need for More Subjective Information
The following extra inquiries have to be made when gathering this patient’s medical history:

Features of Pain:

“Can you elaborate on the pain? Is it searing, throbbing, dull, or sharp? This will make it easier to determine if the pain is related to an acute infection or something else, such as discomfort that has been referred from another structure.
“Does the pain radiate to other areas, such as the jaw or neck?”
“What is the intensity of the pain on a scale of 1 to 10?”
Features of Drainage:

“How does the drainage appear? Is it bloody, green, yellow, or clear?
“Is there any odor to the drainage?”
“How much drainage have you noticed, and has the amount changed over time?”
Related Symptoms:

“Have you noticed any hearing loss or a feeling of fullness in the ear?”
“Any ringing in the ear (tinnitus) or dizziness?”
“Have you had any recent upper respiratory infections, colds, or sinus issues?”
Current Illness or Accident:

“Have you had any recent ear injuries or trauma?”
“Have you been swimming or exposed to water in the ear recently?”
“Any recent changes in your overall health or medications?”
Previous Health History:

“Have you had any previous episodes of ear infections or ear-related issues?”
“Do you have a history of allergies or sinus problems?”
History of Society:

“Do you use tobacco, alcohol, or recreational drugs?”
“Do you work in an environment with exposure to loud noises, dust, or chemicals?”
2. Other Objective Results to Search for
It is necessary to evaluate the following in addition to the current findings:

Examining the ears:

Auricle palpation: Tenderness felt when the external ear is palpated may be a sign of inflammation or otitis externa.
Examine the area around the ear for any indications of cellulitis or abscess formation: Erythema or swelling surrounding the external ear could indicate an infection that has spread outside of the ear canal.
TM Analysis:

An in-depth analysis of the tympanic membrane (TM) A blocked ear canal (due to exudate, for example) is suggested by the inability to see the TM in the left ear. If at all possible, an otoscope should be used to provide a more comprehensive inspection of the ear canal in order to make sure that the exudate is not concealing a TM perforation or an abscess behind the membrane.
Systemic Analysis:

Check for fever progression: Keep an eye on whether the fever is constant or varies. A fever could indicate a more serious ailment like mastoiditis or an infection like otitis media.
Neuro exam: Look for any indications of vertigo, dizziness, or other neurological deficiencies that could point to an ear infection or a core source of ear discomfort.
Examining the mouth and throat:

Additional analysis of the oropharynx: Erythema in the throat could indicate a systemic inflammation or respiratory infection, which should be investigated further.
3. Ordering Diagnostic Tests
A number of diagnostic tests should be taken into account:

Otoscopic Analysis:

a more comprehensive otoscopic examination to evaluate the ear canal and tympanic membrane (TM). A culture of the exudate can be necessary if it obscures the TM.
Culture of Ears:

To determine the precise pathogen (bacterial or fungal) causing the infection, a culture of the ear drainage is performed. A bacterial pathogen such as Staphylococcus aureus or Pseudomonas aeruginosa is more likely to be the cause of purulent discharge.
Testing for audiometrics:

If the patient reports hearing loss, conductive hearing loss—which could be the result of an ear infection or fluid buildup—can be evaluated using audiometry.
Cultures of Blood:

Blood cultures can be taken to check for bacteremia if the patient is feverish and there is a suspicion of mastoiditis or a systemic infection.
MRI or CT scan (if required):

Imaging may be required to assess the extent of the infection if there are indications of a more serious consequence, such as mastoiditis or a deep-seated infection.
4. Differential Diagnoses Otitis Externa: Justification: It is frequently caused by a bacterial infection and is a common cause of ear pain and leakage. Acute otitis externa is indicated by the distinctive white discharge and crusting in the ear canal, as well as pulsating discomfort (Swanson & Benninger, 2020). The lack of TM visibility points to exudate accumulation or canal blockage.
Otitis Media with Effusion: Justification: Given the patient’s fever and ear pain, particularly in light of the drainage, otitis media may be the cause. The effusion may be blocking the vision of the membrane, as shown by the inability to see the TM (Tiemstra, 2019).
Mastoiditis: Justification: Mastoiditis should be taken into consideration in light of the fever and ear pain, particularly if the infection progresses from the middle ear to the mastoid bone. This problem can develop quickly, and imaging may be necessary to rule out complications even though there is no obvious enlargement behind the ear (Fisk & Wasserman, 2019).
5. Justifications for Differential Diagnoses Otitis externa: Usually brought on by bacterial infections (like Pseudomonas aeruginosa), this ailment is typified by ear canal pain and discharge, frequently accompanied by erythema and pruritus. This diagnosis is likely due to the ear canal’s crusting and leakage.
Medial Otitis with Effusion:
This happens when fluid accumulates behind the TM, frequently as a result of a previous bacterial or viral infection. This is a reasonable diagnosis given the lack of a light reflex and TM vision, particularly when fever is present.
When an infection spreads to the mastoid process, it can result in mastoiditis, a dangerous side effect of otitis media that causes severe discomfort, fever, and swelling behind the ear. Mastoiditis should be taken into consideration if the patient’s fever does not go away after receiving first therapy or if the ear pain gets worse.
In conclusion
A comprehensive examination is necessary to identify the underlying cause of the 57-year-old man patient’s left ear pain and discharge. Mastoiditis, otitis externa, and otitis media with effusion are possible diagnosis. To confirm the diagnosis and choose the best course of treatment, diagnostic procedures such otoscopic examination, ear culture, and audiometry are crucial. A comprehensive examination, patient education, and coordination with the interdisciplinary team for diagnosis and therapy are all part of the nurse’s role in managing these illnesses.

Citations
Wasserman, J. R., and R. G. Fisk (2019). Mastoiditis: Identification and management. 118–124 in American Family Physician, 99(2).
Benninger, M. S., and Swanson, J. D. (2020). Otitis externa: Modern theories and practices. Otolaryngology in the American Journal, 41(5), 102506. The publication https://doi.org/10.1016/j.amjoto.2020.102506
J. D. Tiemstra (2019). Effusion and otitis media: Current approaches to treatment. Review of Pediatrics, 40(5), 231-241. The document https://doi.org/10.1542/pir.2018-0298

 

 

 

QUESTION

Module 3 Discussion

  Skin, Eye, & Ear Disorders

 

For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases. Your instructor will assign you your case number.

 

 

	Case 1
Chief Complaint (CC)	A 57-year-old man presents to the office with a complaint of left ear drainage since this morning.
Subjective	Patient stated he was having pulsating pain on left ear for about 3 days. After the ear drainage the pain has gotten a little better.
VS	(T) 99.8°F; (RR) 14; (HR) 72; (BP) 138/90
General	well-developed, healthy male
HEENT	EAR: (R) external ear normal, canal without erythema or exudate, little bit of cerumen noted, TM- pearly grey, intact with light reflex and bony landmarks present; (L) external ear normal, canal with white exudate and crusting, no visualization of tympanic membrane or bony landmarks, no light reflex EYE: bilateral anicteric conjunctiva, (PERRLA), EOM intact. NOSE: nares are patent with no tissue edema. THROAT: no lesions noted, oropharynx moderately erythematous with no postnasal drip.
Skin	No rashes
Neck/Throat	no neck swelling or tenderness with palpation; neck is supple; no JVD; thyroid is not enlarged; trachea midline

 

 

Answer the following questions for your specific case study assigned:

1. What other subjective data would you obtain specific to your case?

2. What other objective findings would you look for?

3. What diagnostic exams do you want to order?

4. Name 3 differential diagnoses based on this patient’s presenting symptoms.

5. Give rationales for each differential diagnosis.

 

· Your initial post  should be at least 500 words, formatted and cited in the current  APA style with support from at least  3 academic sources.

Due Wednesday Oct 30 at 11:59pm