Endgames Case Report

A man with pain in his right ear

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1739 (Published 21 March 2013) Cite this as: BMJ 2013;346:f1739
  1. Leigh Sanyaolu, ear, nose, and throat core surgical trainee,
  2. Sarah Farmer, ear, nose, and throat specialist registrar,
  3. Ali Raza, ear, nose, and throat consultant
  1. 1Ear, Nose, and Throat Department, Royal Gwent Hospital, Newport NP20 2UB, UK
  1. Correspondence to: L Sanyaolu lnsanyaolu{at}doctors.org.uk

A 48 year old man presented to the accident department with a three day history of right ear pain, yellow ear discharge, and mild hearing loss. He had seen his general practitioner two days before and had been prescribed oral antibiotics (amoxicillin 500 mg three times a day) and analgesia. However, over the past 24 hours the pain had got much worse and he was feeling generally unwell. His right pinna and surrounding skin had become red and tender.

He had no relevant medical history, was taking no regular drugs, and had no known allergies.

His right pinna was erythematous, with oedema visible at the external auditory meatus and concha. There was discharge in the intertragal notch and crusted debris over the lobule. Some erythema extended into the neck, inferior to the pinna. He was afebrile and the tympanic membrane was partly visualised and appeared normal. The external auditory canal was about 80% stenosed and there was discharge within the canal. He had no signs of meningism, no evidence of mastoiditis, and no cervical lymphadenopathy. Blood tests showed a white cell count of 12×109/L (reference range 4-11×109) and a C reactive protein of 100 mg/L (<5 mg/L; 1 mg/L=9.52 nmol/L).

Questions

  • 1 On the basis of the history and examination findings, what is the likely diagnosis?

  • 2 What are the common predisposing risk factors for this condition?

  • 3 What are the most common causative organisms?

  • 4 How is this condition managed?

Answers

1 On the basis of the history and examination findings, what is the likely diagnosis?

Short answer

This patient has right otitis externa with cellulitis of the pinna and surrounding soft tissue.

Long answer

Our patient …

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