The following are Red flags to look out for. We have included more information on primary neoplasms of the ear here to focus on for you.
-Primary neoplasms of the ear
Although we have to consider red flags, malignancies are very rare and usually clearly identified when they occur on the auricle and originate in the peri-auricular region.
Malignancy of the temporal bone and external auditory canal are rarer still, but should be considered in a patient with otalgia and a chronic ear discharge.
Skull-base osteomyelitis (or malignant otitis externa) should always be considered in patients who are immunosuppressed or have diabetes with severe otalgia and a history of otitis externa.
The organisms are typically pseudomonas or fungal.
The pain is often described as severe and throbbing and the patient often complains of jaw pain.
All cancers of the head and neck should be ruled out as a secondary cause of Otalgia in patients who have an otherwise normal Otology history and examination.
Oral neoplasms (soft palate, posterior pharyngeal wall, tonsil or tongue base) can also present with intense otalgia.
Exercised 11: Add to your workbook the additional symptoms or risk factors which Pat may present with if they have a possible neoplasm.
– Tinnitus is associated with a high risk of suicide
– Sudden onset of significant neurological symptoms
– Acute uncontrolled vertigo
– Suspected stroke
– Secondary to head trauma
– Tinnitus and hearing loss that has developed over the last 3 days or less
(CKS guidelines April 2022)
– Airway obstruction
– Severe Epistaxis
Can you think of any other red flags?