9-year-old with right-sided ear pain x 1 day
Patient will present as → a 9-year-old female with right otalgia and a nonproductive cough for one day. The patient complains of constant popping in her ears and fluctuating conductive hearing loss with tinnitus. The patient has no significant past medical history, her immunizations are up to date, and both of her parents are non-smokers. On otoscopic examination, the tympanic membranes are grey with normal landmarks, including visualization of the middle ear ossicles. There is no evidence of bulging pus or exudate suggestive of an acute inflammatory process.
The eustachian tube connects the middle ear to the nasopharynx and is useful for equalizing pressure across the tympanic membrane, protecting the middle ear from reflux, and clearing out middle ear secretions
- Eustachian tube dysfunction (ETD) is defined as a failure of the functional valve of the eustachian tube to open and/or close properly
- ETD usually follows the onset of an upper respiratory infection
- Will present with ear fullness, popping of ears, underwater feeling, intermittent sharp ear pain, fluctuating conductive hearing loss, and tinnitus
- Eustachian tube dysfunction is a primary cause of acute otitis media (AOM) and otitis media with effusion (OME)
- All children < 7 years old have some ET dysfunction
An excellent otoscopic exam is the key to making this diagnosis – otoscopic findings are usually normal. May see fluid behind TM if acute serous otitis media
- The definitive diagnosis is with a tympanogram
- In cases of persistent effusion, CT or MRI may be indicated (neoplasm may cause eustachian tube obstruction)
Note that the tympanic membranes are grey with normal landmarks including visualization of the middle ear ossicles. There is no evidence of bulging pus or exudate suggestive of an acute inflammatory process.
All children < 7 years old have some ET dysfunction (based on the angle of the Eustachian tube) that will resolve with age
- Ibuprofen as needed for pain
- Nasal steroids can be prescribed in more severe cases
- Systemic decongestants, such as pseudoephedrine or phenylephrine, may be helpful for nasal congestive symptoms
- Surgery (tympanostomy tubes) is generally indicated when medical management fails
 Osmosis |
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Question 1 |
Meningitis Hint: Sensorineural hearing loss can be caused by meningitis and other congenital infections, intracranial hemorrhage, chronic noise exposure, congenital defects, medications that are ototoxic, and trauma. | |
Medications Hint: Sensorineural hearing loss can be caused by meningitis and other congenital infections, intracranial hemorrhage, chronic noise exposure, congenital defects, medications that are ototoxic, and trauma. | |
Chronic eustachian tube dysfunction | |
Intracranial hemorrhage Hint: Sensorineural hearing loss can be caused by meningitis and other congenital infections, intracranial hemorrhage, chronic noise exposure, congenital defects, medications that are ototoxic, and trauma. | |
Chronic exposure to loud noises Hint: Sensorineural hearing loss can be caused by meningitis and other congenital infections, intracranial hemorrhage, chronic noise exposure, congenital defects, medications that are ototoxic, and trauma. |
References: Merck Manual · UpToDate