A 26-year-old male presents to the emergency department at 1 am complaining of right ear pain. He reports the pain started about three days ago and has gradually gotten worse. He’s used ibuprofen and acetaminophen for the discomfort which has been partially helpful. He has not had any other symptoms – no fevers, cough, congestion nor rhinorrhea. He indicates he swam in the local lake about a week ago. He does not have any history of ear infections. This image of his right ear was obtained.
The patient has both otitis externa and mild acute otitis media.
This is a common clinical case. Ear pain with features on exam consistent with both otitis externa and acute otitis media (AOM). Regarding the otitis externa, there is clear inflammation of the external ear canal. This appears as the “rough” and red ear canal. Often, otitis externa will also have significant purulent discharge, as in this case. Regarding AOM, there is mild bulging of the tympanic membrane. In this case, the bulging is limited to the pars flaccida portion of the eardrum. AOM can have various levels of bulging and can be marked, as in this case.
In this case, treatment consisted of a systemic antibiotic for AOM along with antibiotic ear drops for the otitis externa. When using the ear drops, it’s important to use ear wicks so that the drops are introduced deep into the external canal.