1. Earache. Any earache or other pain in ears?
* Location – feel close to the surface or deep in the head?
* Does it hurt when you push on the ear?
* Characters – dull, aching, or sharp, stabbing? Constant or come and go? Is it affected by changing position of head? Ever had this kind of pain before?
Rationale: Otalgia may be directly due to ear disease or may be referred pain from a problem in teeth or oropharynx.
* Any accompanying cold symptoms or sore throat? Any problems with sinuses or teeth?
Rationale: Virus/bacteria from upper respiratory infection may migrate up Eustachian tube to involve middle ear.
* Ever been hit on the ear or on the side of the head, or had any sport injury? Ever had any trauma from a foreign body?
Rationale: Trauma may rupture the tympanic membrane.
* What have you tired to relieve pain?
Rationale: Assess effect of coping strategies.
2. Infections. Any ear infections? As an adult, or in childhood?
* How frequent were they? How were they treated?
Rationale: A history of chronic ear problems alerts you to possibility of sequelae.
3. Discharge. Any discharge from your ears?
* Does it look like pus, or bloody?
* Any odor to the discharge?
* Any relation between the discharge and the ear pain?
Rationale: Discharge (otorrhea) suggests infection; it may come from canal or may indicate a perforated eardrum. For example: External otitis – purulent, sanguineous, or watery discharge. Acute otitis media with perforation – purulent discharge. Colesteatoma – dirty yellow/gray discharge, foul odor. Typically with perforation – ear pain occurs first, stops with a popping sensation, then drainage occurs.
4. Hearing loss. Ever had any trouble hearing?
* Onset – Did the loss come on slowly or all at once?
inflammation.
Rationale: Presbycusis has a gradual onset over years, whereas a hearing loss due to trauma is often sudden. Any sudden loss in one or both ears not associated with upper respiratory infection warrants referral.
