Advanced Physical Assessment D.W.2

Advanced Physical Assessment D.W.2

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Complications of ear pain present in adults and children. The differential diagnoses in such cases areotitis media and otitis externa including other complications. This paper provides an overview of the two conditions and the factors to consider for differential diagnosis.

Otitis Media (OM)

Otitis media is the inflammation/infection of the middle ear. It starts with an infection making it a middle ear infection occurring when fluid blocks the Eustachian tubes. The symptoms include fever, pain, and impaired hearing and in children troubled sleep, irritability, constant crying, and ear pulling (Acton, 2012). The causes are respiratory infection, allergies, exposure to cigarette smoke, tonsillitis, and for infants feeding while lying down.

Otitis Externa (OE)

Otitis externa is inflammation/infection of the external auditory canal or the ear auricle and times both the external auditory canal and the auricle. It is due to a bacterial infection, irritation, fungal infections, or allergic reactions (Osguthorpe& Nielsen, 2011). The signs and symptoms are hearing loss, tinnitus, occasional fever, erythema, itching, severe deep pain, discharge from the ears, cellulitis, ear pressure, edema, and other bilateral symptoms.

Physical Exam Findings

Physical examination of OM involves the middle ear’sotoscopy. Thefindings are the presence of erythema, bulging, cloud-like appearance, immobility of the tympanic, and presence of an effusion with an inflamed ear canal (Acton, 2012). For OE, physical examination is through the palpitation of the tragus. The external ear canal has edema, narrowing of the canal, erythema, and a cloudy and inflamed tympanic membrane.

Difference in Child and Adult Assessment

During assessment the difference is in the position of conducting the assessment. Childrenlie down with their head turned on one side(Acton, 2012). For adults, they are required to sit with the head tilted on the opposite shoulder. Moreover, pulling of pinna is effective in assessment for children.

Essential Health History Questions

The primary questions to be asked to determine the type, cause and extent of the disease including how the infection began and the duration of the infection. In addition, the current prognosis, onset, and past and family history should be sought. These should be impartial and objective to provide a clear hereditary and medical history.


Ear pain is often a diagnostic problem especially examination exhibits no pathophysiology. The pain can be due to inflammation/infection making it vital to conduct a critical assessment while observing the areas discussed above to eliminate any confusion and ensure the provision of the appropriate treatment.


Acton, Q. A. (2012). Otitis Media: New Insights for the healthcare professional: 2011 Edition: Scholarly Paper. Atlanta, GA: Scholarly Editions.

Osguthorpe, J. & Nielsen, D. (2011). Otitis Externa: Review and clinical update. South African Family Practice, 53(3), 223-229.