Paediatrics - Queensland Health - Queensland Government

Ear problems
2. Immediate management
• Consult MO for referral to Paediatrician or ENT Specialist
3. Clinical assessment
• Obtain a complete patient history. See Assessment of the ear
• Perform standard clinical observations
• Perform physical examination. See Assessment of the ear
596
-- on otoscopic examination - white mass behind an intact ear drum:
○ a deep retraction pocket with or without granulation and skin debris
○ focal granulation on the surface of the drum, especially at the periphery
○ perforation in the attic region (unsafe perforation)
4. Management
• If suspected refer ENT Specialist
5. Follow up
If confirmed, surgical treatment is required
6. Referral / consultation
Refer to Paediatrician and / or ENT Specialist
Controlled copy V1.0
Acute mastoiditis
Recommend
Urgent referral to hospital with paediatric and ENT Specialist for management
Background
Mastoiditis is inflammation in the mastoid air cells and typically occurs after acute
otitis media
Related topics
Acute otitis media Ear wick technique for otitis externa
Assessment of the ear
1. May present with
• As per Acute otitis media; in addition:
-- may have systemic features - with fever and rigors
-- pain swelling and tenderness above and behind the ear over the mastoid
(bony prominence behind the ear)
-- the ear may be pushed away from the head by swelling of the mastoid area
-- dizziness or tinnitus (ringing in the ears) may be present
2. Immediate management
• Consult MO immediately
3. Clinical assessment
• Obtain a complete patient history. See Assessment of the ear
• Perform standard clinical observations
• Perform physical examination. See Assessment of the ear plus:
- - palpate behind the ear. Palpate the mastoid tip noting any tenderness
- - is the mastoid bone swollen and / or hot - describe
- - palpate the occiput, around the ears, both sides of the neck for lymph glands
Primary Clinical Care Manual 2011