Very few ED visits for otologic complaints are actually warranted, said Sujana S. Chandrasekhar, MD, clinical professor at Hofstra-Northwell School of Medicine in Hempstead, N.Y., and president of the American Academy of Otolaryngology-Head and Neck Surgery Foundation. In another study conducted by Massachusetts Eye and Ear Infirmary that focused on the subspecialty emergency room as an alternative model for otolaryngologic care, 6% of visits were for hearing loss (Am J Otolaryngol. 2014:35:758-765). “But hearing loss is not well evaluated in the ED, because no audiologic facility exists there, and, typically, not even a tuning fork is available,” said Dr. Chandrasekhar.
Torree McGowan, MD, an emergency medicine physician at David Grant Medical Center in Fairfield, Calif., also said that it is rare for an ED patient with an ear complaint to have a true emergency. But mastoiditis and perichondritis, although uncommon, both present with ear pain and are justified emergencies. Lacerations involving the pinna are also injuries that must be repaired in a timely manner, to prevent deformity of the pinna caused by improper blood supply during healing. Auricular hematomas can create deformation of the pinna if not drained and dressed properly. Tinnitus can be caused by life-threatening conditions such as aspirin toxicity, carotid artery dissection or aneurysm, and anemia. Foreign bodies in the ear are usually fairly benign, unless they are button batteries, which can cause necrosis of the ear canal if not removed quickly.
Fever of unknown origin in a child younger than two years of age that originates in otitis media can result in meningitis, another true emergency, Dr. Chandrasekhar added.