Pediatric emergency medicine trisk 1124 1124
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sinuses may become infected. A small pit just anterior to the helix, which was
present prior to the development of the infection, is noted in the center of the
surrounding tender, red swelling.
Frostbite of the helix presents as a painful, pale ear that usually becomes
hyperemic and swollen over time. Vesicles may develop in the latter stages. Rapid
rewarming and analgesia are recommended. Most authorities discourage
debridement of vesicular or hemorrhagic lesions.
Cerumen impaction may cause ear pain, especially after attempts to remove
accumulations push the ear wax up against the tympanic membrane (TM). Dry
cerumen may be tightly adherent to the skin of the external canal which, when
removed with a curette, causes abrasion and bleeding. Saline irrigation of the
canal or instillation of peroxide-containing ear drops or docusate liquid can
remove, soften, or detach adherent wax and is recommended prior to attempting
to remove dry cerumen with a curette. Removal of cerumen with a curette is best
accomplished under direct visualization.
Children may have ear pain from foreign bodies placed in the ear. If the foreign
body is difficult to remove or is close to the TM, removal under sedation by an
otolaryngologist is advisable. Occasionally, live insects are noted in the external
canal and their movement causes great pain and distress. Instillation of mineral
oil will asphyxiate the insect prior to removal. Viscous lidocaine may have the
added benefit of paralyzing the insect, reducing painful movements more quickly
than mineral oil.
Shingles of the ear, or herpes zoster oticus, presents with painful or pruritic
vesicles of the external auditory meatus and may also involve the TM. Although
more common in adults, associated facial nerve palsy (Ramsay Hunt syndrome),
hearing loss, or vertigo have been reported in children. Antiviral agents and
systemic corticosteroids may be helpful if administered in the early stages of this
illness.
Labyrinthitis usually presents with vertigo that may be associated with nausea
and vomiting, balance disturbance, and tinnitus. It is usually caused by a viral or
bacterial infection of the inner ear, but may also be associated with middle ear
infection and ear pain.
OTITIS EXTERNA
Otitis externa is inflammation of the skin of external auditory canal often
associated with polymicrobial infection. It is a common problem during
childhood, especially during summer when children are swimming and humidity
is high. Cerumen is produced by glands in the external ear to coat the canal with a
