Case and Discussion
A 21-year-old women comes to your office with a 2 day history of right ear pain. She reports that the ear pain began shortly after taking scuba diving lessons. She describes the pain as “a pressure” and also notes “crackling” in the right ear and periodically feeling dizzy.
- What other associated symptoms should you ask about?
- How does the time course help to distinguish among different causes of ear pain?
- How does the age of the patient help with narrowing the diagnostic possibilities?
- What diagnostic tests do you want to include to help you with your diagnosis?
- Create a differential diagnosis flowsheet for this patient and include the diagnostics as well as the pharmacological management and rationale related to the differentials.
Expert Solution Preview
Introduction:
As a medical professor responsible for designing assignments and providing feedback to college students, it is important to understand the diagnostic process and clinical reasoning skills required for patient evaluation. In this case, we will discuss a 21-year-old woman presenting with ear pain after taking scuba diving lessons.
1. What other associated symptoms should you ask about?
In addition to ear pain, other associated symptoms that should be asked about include hearing loss or ringing in the affected ear, discharge from the ear, fever or chills, and any recent upper respiratory symptoms or allergies.
2. How does the time course help to distinguish among different causes of ear pain?
The time course of the patient’s symptoms can help distinguish among different causes of ear pain. In this case, the pain began shortly after scuba diving, suggesting a possible barotrauma (pressure-related injury) to the ear. Other causes of ear pain, such as infection, typically have a less sudden onset and more gradual progression.
3. How does the age of the patient help with narrowing the diagnostic possibilities?
The age of the patient can help narrow the diagnostic possibilities. In younger patients, barotrauma is a more likely cause of ear pain due to their increased participation in activities such as scuba diving. In older patients, causes such as ear canal infection or age-related hearing loss may be more common.
4. What diagnostic tests do you want to include to help you with your diagnosis?
Diagnostic tests that may be useful include otoscopy to assess the ear canal and tympanic membrane for signs of trauma or infection, audiometry to assess hearing loss, and possibly imaging such as CT or MRI to evaluate for more severe trauma.
5. Create a differential diagnosis flowsheet for this patient and include the diagnostics as well as the pharmacological management and rationale related to the differentials.
Possible differentials for this patient include barotrauma, otitis media or externa, eustachian tube dysfunction, and Meniere’s disease.
For barotrauma, otoscopy may reveal a ruptured tympanic membrane, and management may include analgesics and tympanostomy tubes if necessary.
For otitis media or externa, otoscopy may reveal inflammation or discharge in the ear canal, and treatment may include antibiotics and/or topical steroids.
For eustachian tube dysfunction, audiometry may reveal conductive hearing loss, and management may include decongestant therapy or tympanostomy tubes.
For Meniere’s disease, audiometry may reveal fluctuating hearing loss with vertigo, and management may include a low-salt diet and medication such as diuretics or betahistine.
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