Otitis Externa Case Study

Describe two patients, one who is being seen for OM, and one who is being seen for OE. Identify the symptoms they each present with, what the tympanic membrane and/or canal specifically look like, the selected prescription and the dosage of the prescription.

Otitis Externa or swimmer's ear as it's commonly known, is an acute painful inflammatory disorder of the ear canal. This condition is characterized by a rapid onset of an external ear canal infection, that may extend distally to the pinna and proximal to the tympanic membrane resulting in otalgia, itching, canal edema, erythema, and otorrhea that often occurs after swimming or a minor trauma from inadequate cleaning. This form of ear bacterial infection is often caused by Pseudomonas aeruginosa and Staphylococcus aureus pathogens and can affect individual of all ages (Schaefer, & Baugh,

2012)(Woo, & Robinson, 2016).
On the other hand, Otitis media is characterized by the presence of inflammation and fluid in the middle ear, moderate to severe tympanic membrane bulging.

This acute disorder, mostly affect infants and middle age children, that commonly presents with specific signs and symptoms such ear holding, tugging or pulling that may be accompanied by fever without signs of an acute illness (Pirozzo, & Del Mar, 2011)(Woo, & Robinson, 2016).

Acute Otitis Externa Case Study (AOE) :

A 26 year old female patient presents to the urgent care with a chief complaint of a" wet and painful left ear." The onset of symptoms began 24 hours after she spent the day swimming in her family pool. The patient states experiencing ear fullness and itching, that is unrelieved even after she cleaned her ear with a cotton swab. Upon examination with the otoscope, the ARNP notices a erythematous ear canal with a moderate tympanic membrane edema and a clear exudate. The external surrounding tissue is mildly tender to touch and normal vital signs WNL.

Pharmacotherapeutic treatment:

Combination therapy with topical antimicrobial ophthalmic

preparation.
Ciprodex ( Ciprofloxacin 0.3% /Dermathosne 0.1%): 4 drops in the affected ear x 7 days.
Patient educated about possible side effects and instructed to stop medication if s/s of allergic reaction noted.
Patient instructed to complete medication as recommended, even if symptoms improve.

Acute Otitis Media Case Study (AOM):
A 3 year old female patient was brought to the office by her parents because the infant has develop a fever and was noticed pulling and tugging of the right ear. The mother denies any significant past medical history. The child appears restless and is been crying the entire time since they arrived to the office. During the health interview, the Advanced Clinician learns that the patient often feeds from her baby bottle prior taking a nap or at bedtime at night. Examination reveals, a red, opaque and bulging tympanic membrane, without evidence of discharge and pinnal tenderness, her Temperature is 101 F and she currently weighs 15 Kg.
Pharmacotherapeutic treatment:
Amoxicillin Oral suspension 80-90 mg /kg 2 doses/daily for 10 days
OTC Tylenol / Ibuprofen PRN to reduce fever.
Patient/parents educated about possible side effects and instructed to stop medication if s/s of allergic reaction noted.
Patient/parents instructed to complete medication as recommended, even if symptoms improve.

References:
Pirozzo, S., & Del Mar, C. (2011). Acute Otitis Media. Best Practice Public Health, 175. Retrieved from http://hptt//www.ewjm.com.
Schaefer, P., & Baugh, R. (2012). Acute Otitis External: An Update. American Family Physician. Retrieved from http://www.aafp.org/afp.
Woo, T., & Robinson, M. (2016). Pharmacotherapeutics for advance practice nurse prescribers (4th ed., pp. 92-95). Philadelphia, PA: F. A. Davis Company.