Paediatrics - Queensland Health - Queensland Government
Paediatrics - Queensland Health - Queensland Government
Paediatrics - Queensland Health - Queensland Government
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Ear problems<br />
580<br />
Controlled copy V1.0<br />
Assessment of the ear<br />
History<br />
• Obtain a complete patient history<br />
• Of particular note is environmental history e.g. dusty, passive smoking or smoker<br />
• Social history<br />
• Surgical history, medical history<br />
• Has the patient been swimming?<br />
• Of particular importance are problems with hearing, speech and language<br />
• Does the patient have any pain? Is there pain on movement of the pinna? Describe<br />
pain, how long has the patient had the symptoms? Young children may not be able to<br />
localise their pain but parent may notice they are unsettled or pulling at an ear<br />
• Is the ear itchy?<br />
• Is this the first episode? Note the number of past episodes<br />
• Is there a history of URTI? How many?<br />
• Is the person under the care of ENT physician? Audiologist?<br />
• Is there a history of AOM with perforation?<br />
• Have any measures been used to treat the ear?<br />
Examination<br />
• Examine ear at eye level<br />
• Position infant / toddlers on parent / carer’s knee. Older child can stand and adult sit<br />
• Often very painful - approach gently<br />
Outer ear<br />
• Inspect the external ear - is there any sign of inflammation?<br />
• Palpate the ear - is it warm to touch? Is there pain on moving the pinna?<br />
• Palpate behind the ear? Is the mastoid bone swollen? hot?<br />
• Palpate the occiput, around the ears, both sides of the neck for lymph glands<br />
• Is there auricular tenderness? pain? tenderness on palpation of mastoid?<br />
Ear canal<br />
• Inspect the ear canal for discharge, redness / swelling, fungal membrane or debris,<br />
lumps or bony growths, foreign body, extruding grommets, wax, fluid<br />
• If pain levels allow, inspect the ear canal for inflammation, exudates, lesions or foreign<br />
bodies<br />
Tympanic membrane (ear drum)<br />
• Colour of drum - is it normal - transparent and shiny, or dull?<br />
• Cone of light - right ear at 5 o’clock, left ear at 7 o’clock<br />
• Handle of malleus - right ear 1 o’clock, left ear 11 o’clock<br />
• Is the ear drum intact? bulging? retracted?<br />
• Is there fluid or air / fluid or bubbles behind the ear drum?<br />
Right<br />
Left<br />
Primary Clinical Care Manual 2011
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