Presentation After an upper respiratory tract infection, an episode of acute otitis media (AOM), an airplane flight, or during a bout of allergies, an adult may complain of a feeling of fullness in the ears, an inability to equalize middle ear pressure, decreased hearing, and a clicking, popping, or crackling sound, especially when moving the head. There is little or no pain or tenderness. Otitis media…

Presentation In acute otitis media (AOM), adults and older children will complain of ear pain (and/or fever) that is usually rapid in onset. There may or may not be accompanying symptoms of upper respiratory tract infection. In the younger child or infant, parents may report irritability, decreased appetite, and sleeplessness, with or without fever or pulling at the ears. The real diagnosis comes not from symptoms…

Presentation In acute otitis externa (AOE), the patient complains of ear pain, which is always uncomfortable and sometimes unbearable, often accompanied by drainage and a blocked sensation, decreased hearing, and sometimes fever. When the condition is mild or chronic, there may be itching rather than pain. Pulling on the auricle ( Fig. 35.1 ) or pushing on the tragus of the ear classically causes increased pain.…

Presentation After a direct blow to the nose, a patient may present with concern that their nose is broken. There is usually minimal bleeding. There may be tender ecchymotic swelling over the nasal bones or the anterior maxillary spine, and inspection and palpation may or may not reveal nasal deformity. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles…

Presentation The patient is usually an adolescent or a young adult between the ages of 15 and 25 complaining of several days of fever, malaise, myalgias, and anorexia, culminating in a severe sore throat. The physical examination is remarkable for lymphadenopathy, typically bilateral posterior cervical chains, and enlarged tonsils, at times meeting in the midline and covered with an exudate, which can be white, green, yellow,…

Presentation A child, most often between the ages of 6 months and 3 years (peak incidence 1–2 years, rarely seen >6 years), arrives with a characteristic barking cough that sounds very much like the bark of a seal. The patient may arrive with reports of having significant difficulty breathing in the middle of the night. There is usually a prodrome of low-grade fever and symptoms of…

Presentation Patients may present with the sensation of a foreign body (FB) stuck in their throat. They typically can still feel a sensation in the throat, especially (and perhaps painfully) when swallowing. They may be able to precisely localize the FB sensation above the thyroid cartilage (which implies the possibility of a FB in the hypopharynx that may be visible) or may only vaguely localize the…

Presentation Children frequently present after inserting foreign bodies (FBs) into their nares. They may report the FB, or the event may be observed. Sometimes, however, the history is obscure, and the child presents with local pain; a purulent, unilateral nasal discharge; epistaxis; a nasal voice change; or foul breath. The most commonly encountered nasal FBs are beans, peanuts or other foodstuffs, beads, toy parts, pebbles, paper…

Presentation Children may present after placing small objects such as a bead, a small stone, folded paper, or a bean in their ear. At times, the history is not revealed, and the child simply presents with a purulent discharge, pain, bleeding, or hearing loss. Adults also occasionally present with foreign bodies (FBs) in the auditory canal, often the result of trying to remove earwax. A panic-stricken…

Presentation Patients may arrive in the emergency department (ED) or urgent care center with active bleeding from their nose or spitting up blood that is draining into their throat from a nasal source. There may be a report of minor trauma, such as sneezing, nose blowing, or nose picking. On occasion, the hemorrhage has stopped, but the patient is concerned because the bleeding has been recurrent…

Presentation The patient may complain of “wax in the ear,” a “stuffed-up” sensation, pain, itching, decreased hearing, tinnitus, dizziness, hearing aid malfunction, ear drainage, or ear odor. Symptoms may be sudden in onset if the patient put a cotton-tipped applicator down the ear canal or placed something like mineral oil into the ear canal in an attempt to soften the wax. On physical examination, there is…

Presentation The patient arrives in the emergency department (ED) or clinic complaining of severe, intense, burning eye pain, usually bilateral, beginning 6 to 12 hours after a brief exposure without eye protection to a high-intensity ultraviolet (UV) light source, such as a sunlamp or welder’s arc. The eye examination shows conjunctival injection and tearing; fluorescein staining may be normal or may show diffuse superficial uptake (discerned…

Presentation This condition may occur spontaneously or may follow minor trauma, coughing, vomiting, straining at stool, or exercising heavily. There is no pain or visual loss, but the patient may be frightened by the appearance of the affected eye and have some sensation of superficial fullness or discomfort. Often a friend or family member is frightened by the appearance and insists that the patient see a…

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Presentation The patient has suffered blunt trauma to the eye, most often resulting from a blow, a fall, a sports injury, or a car accident, and is alarmed because of the swelling and discoloration. Family or friends may be more concerned than the patient about the appearance of the eye. There may be an associated subconjunctival hemorrhage, but the remainder of the eye examination should be…

Presentation The patient is frightened by facial distortion and itching that appeared either spontaneously or up to 24 hours after being bitten by a bug or coming in contact with some irritant. One or both eyes may be involved. The patient may have been rubbing their eyes; however, an allergen or chemical irritant may cause periorbital edema long before a reaction, if any, is evident on…

Presentation The patient usually complains of the onset over hours or days of unilateral eye pain, blurred vision, and photophobia. He may have noticed a pink eye for a few days, suffered mild to moderate trauma during the previous day or two, or experienced no overt eye problems. There may be tearing but usually no discharge. Eye pain is not markedly relieved after instillation of a…

Presentation The patient complains of redness, nodular swelling, and pain in the eyelid, perhaps at the base of an eyelash (stye or external hordeolum) or deep within the lid (meibomitis, meibomianitis, or internal hordeolum, which is best appreciated with the lid everted) and perhaps with conjunctivitis and purulent drainage. In some cases, the complaint may be that of generalized edema and erythema of the lid (cellulitis).…

Presentation Patients often present after eye injury from falling or airborne particles such as rust, particles from metal grinding, windblown grit, and wood or masonry from construction sites. The patient will complain of a foreign-body sensation and tearing and, possibly over time, will develop constant pain, redness, and photophobia (posttraumatic iritis). Moderate-velocity to high-velocity foreign bodies (fragments chipped from a chisel when struck by a hammer…

Presentation Low-velocity projectiles, such as windblown dust particles, can be retained in the tear film, the upper tarsal plate, or in a conjunctival sac. The patient will feel a foreign-body sensation but may not be very accurate in locating the foreign body by sensation alone. On examination, normally occurring white papules inside the lids can be mistaken for foreign bodies, and transparent foreign bodies can be…