Unilateral Otorrhoea 2

Take a history from the parent of a 2 year old with hearing loss. An otoscopic picture is provided.

History

  • Unilateral or bilateral hearing loss

  • Onset

  • Duration

  • Timing – intermittent/constant

  • Character – foul-smelling, clear (CSF), bloody (malignancy)

  • Exacerbating and relieving factors – previous treatments by GP/ENT specialists, any previous imaging? 

  • Associated symptoms – vertigo, tinnitus, otalgia, headache, photophobia, mastoid swelling and/or tenderness

  • Past Medical History – previous otological pathology, previous otological surgery, infectious disease, head injury, eczema, psoriasis, seborrhoeic dermatitis, cotton bud use, diabetes, barotramua

  • Paediatric Hx – Pregnancy and birth Hx, neonatal Hx, Vaccination Hx (if applicable), outcome of newborn hearing screening

  • Drug History – cisplatin-based chemotherapy, immunosuppressants

  • Social History – smoking, alcohol, occupation, hobbies

  • Family History – otological conditions, genetic syndromes

  • Systems review

  • Elicit the patient’s ideas, concerns and expectations 


Conclusion

  • Summarise consultation

  • Thank patient

  • Offer appropriate differential diagnosis

Differential diagnoses to consider*

Benign

  • Cholesteatoma (destructive)

Infection

  • Otitis externa

  • Chronic suppurative otitis media

Other

  • Foreign body

  • Skull base fracture

  • Tumour

*Table not exhaustive


Management


You will be asked to suggest an appropriate management plan based on your presumed diagnosis. Ensure that you offer a complete ENT examination including microscopic examination of the ear canal and tympanic membrane in addition to cranial nerves prior to further investigations. 

Some examples are below:-

Suspected diagnosis

The following investigations/management strategies may be indicated however you must offer based on the clinical scenario you are given

Cholesteatoma

Clinical diagnosis. CT temporal bones for surgical planning. 

Consider MRI brain if any central neurological features

Skull base fracture

CT skull base


You may also mention that you would ask for a senior opinion and inform the patient of the outcome if you are unsure.

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