Case #3: Focused Ear Exam
Martha brings her 11-year old grandson, James, to your clinic to have his right ear
checked. He has complained to her about a mild earache for the past two days. His
grandmother believes that he feels warm but did not verify this with a thermometer. James
states that the pain was worse while he was falling asleep and that it was harder for him to
hear. When you begin basic assessments, you notice that James has a prominent tan. When
you ask him how he’s been spending his summer, James responds that he’s been spending a
lot of time in the pool.
With regard to the case study:
- Consider what history would be necessary to collect from the patient.
- Consider what physical exams and diagnostic tests would be appropriate to gather more
information about the patient’s condition. How would the results be used to make a
diagnosis? - Identify at least 10 possible conditions that may be considered in a differential diagnosis
for the patient.
** Write a description of the health history you would need to collect from the patient in
the case study to which you were assigned. Explain what physical exams and diagnostic
tests would be appropriate and how the results would be used to make a diagnosis. List five
different possible conditions for the patient’s differential diagnosis and justify why you
selected each.
USE RESOURCE OF 5 OR LESS YEARS OLD.
Assessing the Ears, Nose, and Throat
Health history
The doctor will have to establish when exactly the pain began and if it came on quickly.
The physician will also assess if there is redness and swelling in the ear. Using a thermometer,
the physician will establish if there has been fever (National Health Service, 2012). It will also be
important to assess for hearing impairment through speaking at different tones and when far
away. In addition, ear pain will be assessed though through pressing various areas of the ear.
Usually, the ear pain, fever, and hearing impairment results from mucous or fluid trapping or
ASSESSING THE EARS, NOSE, AND THROAT 2
accumulation in the middle ear. The physician should establish if there has been a recent
respiratory tract infection (National Health Service, 2012).
In addition, the physician should seek from the grandmother if James has been irritable,
pulling or tugging at the ears, if there is any form of discharge from the ears, loss of balance,
vomiting and nausea, diarrhea, reduced appetite, and congestion. Having facts on these will
enable to establish the kind of middle ear infection James has.
Diagnostic tests and physical exams
The physical examination will be conducted by assessing if there is any discharge,
touching parts of the ear to establish if there is pain, and assessing for hearing problems. Second,
a medical history will be conducted (National Health Service, 2012). Third, the physician will
carry out an inspection of the outer ear as well as the ear drum using a otoscope. A
tympanometry will establish the functioning of the middle ear by detecting pressure changes.
An infected ear has many redness and dullness areas. In addition, there might be fluid or
air bubbles behind the ear drum. A reflectometry measures sound transmissions. As a result, the
doctor can establish if there is any fluid accumulation behind the eardrum (National Health
Service, 2012).
Possible conditions from the differential diagnosis include;
Otitis externa- infections because of spending too much time in the pool
acute otitis media- it is a common ear infection in children
Infectious myringitis because of the pain
Chronic otitis media- infections are a result of swimming
Acute mastoiditis- fever
ASSESSING THE EARS, NOSE, AND THROAT 3
Reference
National Health Service. (2012). Middle Ear Infection (Otitis Media).