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17 results

An Introduction to Clinical Emergency Medicine
  • 2nd edition
  • Edited by S. V. Mahadevan, Gus M. Garmel
  • Published online: 05 May 2012
  • Print publication: 10 April 2012
  • Building on the strengths of its award-winning predecessor, this new edition of An Introduction to Clinical Emergency Medicine is a must-have resource for individuals training and practising in this challenging specialty. Guided by the patient's chief complaint, this text presents a concise, methodical approach to patient evaluation, management and problem solving in the Emergency Department. Unlike other textbooks, which elaborate on known diagnoses, this extraordinary book approaches clinical problems as clinicians approach patients - without full knowledge of the final diagnosis. Fully revised and updated, the second edition includes new chapters on sepsis, bleeding, burns, neonatal, alcohol-related, and dental emergencies. Stunning full-color chapters include clinical images (photographs, ECGs and radiologic studies), detailed illustrations and practical tables. Written and edited by experienced educators, researchers, and practitioners in Emergency Medicine, this text is core reading for students and residents, and an important resource for practising emergency physicians, faculty, and other healthcare providers.

  • 19 - Ear pain, nosebleed and throat pain (ENT)

  • Swaminatha V. Mahadevan, Stanford University School of Medicine, California, Gus M. Garmel, Stanford University School of Medicine, California
  • Book: An Introduction to Clinical Emergency Medicine
  • Published online: 27 October 2009
  • Print publication: 26 May 2005, pp 253-286

  • Summary

    Scope of the problem

    Ear pain (otalgia) is a common emergency department (ED) complaint. It prompts over 30 million physician visits per year. By the third year of life, 80% of the population will have complained of otalgia at least once. Though many conditions may cause ear pain, otitis media (OM) is by far the most common diagnosis, especially in the pediatric population. The potential for serious causes of otalgia, such as malignant otitis externa (OE) and mastoiditis, underscore the need for early and accurate diagnosis and treatment.

    Anatomic essentials

    The anatomic ear may be divided into three distinct sections: external, middle and inner (Figure 19.1). The external ear, consisting of the auricle (pinna) and the external auditory canal (EAC), originates at the pinna and ends at the tympanic membrane (TM). The middle ear is an air-containing cavity in the petrous temporal bone that houses three auditory ossicles: the malleus, incus and stapes. Though the middle ear is separated from the outer ear by the TM, it connects anteriorly with the nasopharynx via the eustachian tube, and posteriorly with the mastoid air cells. The inner ear includes the cochlea, which contains the auditory receptors, and vestibular labyrinth, which contains the balance receptors. Sensory innervation of the ear is derived from branches of cranial nerves (CNs) V, VII, IX and X as well as I, II and III.

    Primary otalgia (Table 19.1) is ear pain that results from structures directly within or adjacent to the anatomic ear.