1. Symptoms and clinical features of diffuse otitis externa
The external part of the ear canal is painful (especially the tragus);
Ear congestion, hearing loss;
Fever is uncommon.
Swelling and hyperemia of the skin of the ear canal;
Serous or purulent discharge;
Accumulation of debris in the ear canal;
Tympanic membrane appears to be normal.
2. Symptoms and clinical features of acute otitis media (AOM) – suppurative form
Nasal discharge and congestion;
If perforation is present: otorrhea
Ear canal appears to be normal;
Hyperemia of tympanic membrane;
Later in the course of the disease: marked bulging of the tympanic membrane, subsequently spontaneous perforation can develop.
3. Causes of acute hearing loss
wax, foreign body;
acute tubal occlusion, otitis media (OME/AOM);
trauma (e.g. perforation of the tympanic membrane).
Noise (acute) induced hearing loss;
Toxical damage (medication, chemicals);
4. What is to be done in case of acute sensorineural hearing loss?
In case of acute sensorineural hearing loss, immediate intravenous nootropic/vasodilatating therapy or steroid bolus treatment is necessary with hospitalization; meanwhile detailed investigation is required to be carried out to clarify the etiology. The earlier the treatment is started, the better the outcome is.
Lumps in the upper respiratory tract: abscess, granulation tissue, malignancies;
Non-specific reactions of the upper respiratory mucosa: allergy, Reinke edema, hereditary angioneurotic edema;
Recurrent laryngeal nerve palsy.
33. Middle-aged, smoker patient presents with unilateral ear pain, but the examination of the ear does not reveal any disorders. What may be the cause, and what is obligatory to be examined?
Unilateral, referred ear pain is a typical finding in patients with hypopharyngeal (less commonly supraglottic and oropharyngeal) malignancies. This symptom and the tobacco use in the patient history make the examination of the oral cavity, oropharynx/hypopharynx, larynx and the neck obligatory.
34. Management of choking patients – if intubation cannot be carried out
1. Cricothyrotomy – in the lack of time and appropriate tools: we find the cricothyroid ligament above the cricoid cartilage (using fingers), and after carrying out a transversal incision on the skin, we pierce the ligament with any instrument at hand, and insert a holed tool (e.g. outer tube of a pen).
2. Tracheotomy – After incising the skin and the platysma, we find (and if necessary - ligate) the isthmus of the thyroid gland, and - at the 2nd or 3rd tracheal cartilage - we make an incision on the anterior wall of trachea (in childhood) or remove a part of the cartilage (in adults). We insert a tube/cannula in order to maintain the free airway.