Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

Wilderness and Rescue Medicine 200

Q-tips, because they will further irritate the ear canal. Once the ear canal is infected, the ideal treatment is antibiotic eardrops, available in the United States only by prescription.

In the field, temporary pain relief may be obtained with topical pain relievers like Orabase or oil of cloves, and with oral or injectable pain medication. If immediate evacuation is not pos- sible, begin high-dose antibiotics and warm compresses. This may reduce the severity of the infection pending evacuation to dental care. In a worst-case scenario, remember that up until quite recently in dental history, pulling the tooth was the definitive treatment for dental infection.

External Ear Infection

General Principles

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Mechanism: • Skin maceration and bacterial invasion Signs and Symptoms: • Ear canal red and swollen • External ear is tender and painful Treatment:

Dental Abscess

General Principles

• Antibiotic ear drops • Dilute vinegar drops • Oral antibiotics

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Anticipate: • Systemic infection • Impaired food and fluid intake • Pain Treatment: • Pain medication • Urgent evacuation • Antibiotics

Natural Tooth and Root

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Crown Gum tissue Tooth root

Middle Ear Infection and Sinusitis The sinus cavity referred to as the middle ear lies behind the ear drum and extends through a narrow opening into the nasopharynx. Like the other sinus cavities inside the skull, the middle ear is lined with mucous membrane and drains through one small opening. In the healthy indi- vidual, mucous is continuously produced and drained through the eustachian tube into the throat, where it is swallowed. Problems begin when the tube becomes obstructed by swelling and inflammation from a viral infection or as the result of irritation by seawater or smoke. The trapped mucous provides a growth medium for bacteria, and a middle ear infection develops. The typical symptom of middle ear infection is pain. Bending over at the waist increases pres- sure in the affected ear and increases the pain. Middle ear infection can be differentiated from swimmer’s ear by the fact that, although the ear hurts, the external ear structures and ear canal are not red, swollen, or tender to touch. The problem called sinusitis develops by the same mechanism in the frontal, maxillary, or ethmoid sinuses in the skull. Typical non-serious symptoms include sinus pressure, a stuffy nose, and a clear, green or yellow nasal discharge. These are almost always a viral infection (common cold)

Bone

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External Ear Infection Swimmer’s ear is a superficial bacterial infection of the external auditory canal. Also called external otitis, it develops when prolonged exposure to water leads to breakdown of the protective skin barrier. The signs and symptoms are not difficult to distinguish from middle ear infection. Like any infection, swimmer’s ear is character- ized by redness, warmth, swelling, and pain. The external structures of the ear and surrounding area are tender to pressure and manipulation. The external ear canal may be swollen and obstructed. Treatment of Swimmer’s Ear Using mineral oil drops before swimming reduc- es maceration of the skin and the incidence of infection. A few drops of vinegar combined with alcohol instilled into the ear canal after swim- ming is a good preventive treatment. There are also commercial preparations, such as SwimEar, available over the counter to help prevent exter- nal otitis. Do not use dry cotton swabs, such as