The clinical presentation for ear complaints can often overlap with other common pediatric conditions. As such, the differential diagnosis for ear complaints is broad, warranting a thorough history and targeted physical examination. Optimizing the approach for a definitive ear examination is essential when evaluating a pediatric patient with an ear concern. A systematic approach will improve the accuracy of diagnoses and the appropriateness of management.
Our recent issue Management of Common Pediatric Ear Complaints in the Emergency Department provides an evidence-based approach to the diagnosis, workup, and management of common ear complaints in pediatric patients.
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Here are a few key points:
- The differential diagnosis for a patient presenting with ear complaints is broad.
- Ear examinations are often distressing for pediatric patients. Consider starting with a visual inspection of the head and neck region as well as completing less stressful parts of the examination prior to using an otoscope. If a patient becomes upset from an ear examination, it will make the remainder of the physical examination more challenging.
- Consider how to position the patient most comfortably and effectively prior to starting an ear examination. Engage the guardian, child-life specialists, and entertainment options prior to starting the examination. This will lead to a more efficient, less traumatic examination for the patient.
- Not treating or failure of treatment for acute otitis media (AOM) can lead to complications such as a ruptured tympanic membrane, hearing loss, mastoiditis, labyrinthitis, brain abscess, and sinus venous thrombosis.
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