Managing Common Ear Complaints: An ENT's Advice
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Ear pain, itchy ears, wax buildup, swimmer's ear, and more. These expert tips from an otolaryngologist may surprise you. https://www.medscape.com/viewarticle/... -- TRANSCRIPT -- Matthew F. Watto, MD: Welcome to The Curbsiders. I'm Dr Matthew Watto, here with my great friend and America's primary care physician, Dr Paul Nelson Williams. We're about to talk about some pearls on common ear complaints from our podcast with Dr Angela Peng. As primary care physicians, we're all very comfortable taking a history. With the ear, you want to ask about prior infections or surgeries, and whether they are sticking anything in their ear. Do they have any risk for barotrauma, like jumping in a pool, scuba diving, or flying often? We are going to spend most of our time talking about management of common ear complaints. If someone comes in with ear pain, should I just look in their ear and we're good to go? Paul N. Williams, MD: The ear is tricky. Looking in both ears is a great place to start for a patient with ear pain. I look at the unaffected ear first to have a basis for comparison. But the larger point is about the plumbing here. It's all very complicated, and even though the patient's pain is coming from the ear, it can be referred jaw pain from TMJ dysfunction. It could be a tongue malignancy. A great many conditions can cause pain referred to the ear. So, if you look in the ear and don't see any cause for the pain, don't stop because there are many potential causes in the head and neck. Palpate the lymph nodes and do a thorough head exam. Watto: I look in the ear, and in the nose, with a speculum. I look in the mouth and throat as well. You don't want to miss a malignancy or something. You might throw in some allergy testing if there are a lot of sinus symptoms going on, and a CT scan, based on clinical suspicion. But that's usually not something I'm doing at a first visit. Now let's go on to management. Sinonasal symptoms often refer to the ear. All of the ENT doctors we've talked to and all the notes I get back from ENT doctors in practice say that these patients should be doing saline irrigation with either the neti pot or the squeeze bottle, using irrigation solution or making their own formulation at home with distilled water with baking soda and salt so it doesn't burn the heck out of their nose when they use it. That works very well. Most patients with sinus symptoms should be using that. For something like an otitis media, she mentioned antibiotics, but what else did she say might be helpful in treating these patients? Williams: She made a point about the adjunctive therapy — intranasal steroids and antihistamines to kind of clear out the plumbing and make sure that all the tubes are flowing where they're supposed to flow, in addition to the systemic, antimicrobial therapy that you'd be giving the patient. For otitis media specifically, antibiotic ear drops aren't all that helpful. With a really irritated tympanic membrane, she might use topical steroid drops. But that might be above my level of comfort. The adjunctive stuff that we have a lot of comfort with — the intranasal steroids and the antihistamines — we should be prescribing along with antimicrobial therapy. Watto: She mentioned that sometimes she'll even use oral steroids if the patient has tried some of these other things and they are still really congested or inflamed. If you've tried the first-line therapies such as intranasal steroids and saline irrigation and the patient is not getting better, it's always reasonable to refer the patient to someone who can take a deeper look in there. Some patients are going to need a surgical procedure. Transcript in its entirety can be found by clicking here: https://www.medscape.com/viewarticle/...
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