Sakit Telinga


BACKGROUND

A 32-year-old male surfer with a history of recurrent childhood otitis media as well as adenoidectomy and tympanostomy tube placement presents to the emergency department with a complaint of progressive right ear pain that started 2 weeks ago. Four days ago, he had seen an otolaryngologist, who prescribed ciprofloxacin-hydrocortisone ear drops for a diagnosis of otitis externa. Two days after that, the patient was seen in the emergency department because the pain worsened despite treatment, and otitis externa was again diagnosed. Acetaminophen-codeine was added to his regimen of ibuprofen and the topical antibiotic. On this visit, he reports having constant, severe ear pain and headache despite analgesia. He denies having fever and vomiting but says he cannot hear in his right ear. He denies any other medical history, specifically a history of diabetes mellitus.

On physical examination, the patient appears well and has normal vital signs. In his left ear canal are moderate-sized canal exostoses; the left tympanic membrane appears normal. For the right ear, the outer ear canal is patent without notable narrowing, but a purulent, yellow-gray discharge obscures the tympanic membrane and inner canal. No substantial tenderness is noted with gentle traction of the pinna or with compression of the tragus. However, palpation of the temporal bone causes discomfort. No obvious periauricular swelling or mass is observed. The oropharynx is clear without trismus. No lymphadenopathy is noted on neck examination. Neurologic examination reveals no facial weakness, cranial nerve deficit, nystagmus, or cerebellar findings. The rest of the physical examination yields unremarkable findings. CT of the skull and brain is performed (see Image).

What is the diagnosis?

Hint
This condition is an uncommon complication of otitis externa.

Author:

D. Brady Pregerson, MD,
Attending Physician,
Department of Emergency Medicine,
Cedars Sinai Medical Center;
Author, Quick Essentials: Emergency Medicine and Pharm Animals Pharmacopoeia (www.ERpocketbooks.com)

 

 

eMedicine Editor:

Erik D. Schraga, MD,
Staff Physician,
Kaiser Permanente,
Santa Clara Medical Center, Calif

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