Acute otalgia and otorrhoea in primary care

A 26 year old otherwise well man with no medical history of note attended his general practice with a five day history of severe right ear pain and scanty ear discharge. He had returned from holiday one week earlier, where he had been swimming. He had no headache, fever, or systemic upset.

Clinical examination identified oedema and discharge at the right external auditory meatus but an otherwise normal pinna. Palpation of the right tragus caused sudden onset intense pain, and otoscopy showed oedema of the external auditory canal, with a small amount of discharge obstructing visualisation of the tympanic membrane. He had no post-auricular swelling, erythema, tenderness suggestive of mastoiditis, or signs of meningism. His observations were within normal limits.