Ear assessment

• Look at the external ear and surrounding surface, neck and throat for inflammation, discharge or trauma.
• Look at the ear canal for inflammation. The canal may be almost closed in otitis externa.
• Look for discharge.
• Palpate surrounding bony landmarks, including mastoid and temporomandibular joint (TMJ), for tenderness and abnormalities.
• Mastoiditis requires prompt treatment with appropriate IV antibiotics. Escalate care as per local CERS protocol if there is:
  • pain and/or inflammation over the mastoid
  • and/or protruding auricle.
• When there is a foreign body (FB) in the canal, children often self-report, find out:
  • the nature of the object
  • when it was inserted
  • if there have been previous attempts to remove it.

Diagnosing otitis media

A working diagnosis of acute otitis media requires an otoscope inspection of the auditory canal and tympanic membrane. Await review by a medical or nurse practitioner if outside the scope of practice.

High-risk groups requiring senior medical review and antibiotic therapy include:

• Aboriginal or Torres Strait Islanders
• infants less than six months old
• systemically unwell patients
• children at high risk of complications, including the immunocompromised.