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Ear pain 1

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 Scenarios

Ear pain 1
By Isha Hussain   .   July 31, 2024 .   Last reviewed:   24/09/24 .    




Summary

In this scenario, a patient complains of ear pain. The student must take a history, make a diagnosis, and suggest an appropriate course of action

 

Please ensure that this scenario and mark scheme aligns with the most up-to-date guidelines from the UK NICE and the BNF when using it for your OSCE assessment. 

 
You will need a student pharmacist and an actor for this OSCE station. 

Revision Topics
Be aware, this may reveal any answers!

Ear Infection  

Earache  

Student Instructions

You are a pharmacist working in a community pharmacy. The patient is a 35-year-old male complaining of ear pain. You have been asked to take a history, make an appropriate diagnosis and provide the patient with an appropriate over-the-counter medication. 

 

To do: 

  1. Assess the patient's symptoms, develop an appropriate treatment plan, and provide relevant medical or lifestyle advice as needed. 

 

You have 10 minutes.
You have access to the BNF.

 

Actor AI 🤖 (Beta)
Actor Instructions

You are Jayden Davies (Jay-dun Day-Veez) 

 

Opening statement: ‘Hi, I’ve been having lots of pain and itching in my left ear, is there something you can give me for this?’ 

 

Patient information: 

To be given if the student asks. 

  • Name: Jayden Davies 

  • Age: 35 

  • Past medical history:

    • Asthma since 14

  • Medication History:

    • Salbutamol inhaler as needed for asthma 

  • Allergies:

    • No known allergies 

  • Symptoms: 

    • "The symptoms started 3 days ago in my left ear." 

    • "My ear is sore, but it’s not painful in my inner ear." 

 

  • If the pharmacist asks:
    • "I have an itchy ear and it looks a bit red."
    • "There is no discharge."
    • "I don’t have a fever."
    • "I haven’t experienced any hearing loss."
    • "I haven’t had any recent infections or trauma to the ear."
    • “I have not done anything to make it better or worse.” 

 

  • Risk factors to mention when the pharmacist asks:
    • "I returned from holiday 3 days ago, where I was frequently swimming."
    • "I didn’t use earplugs or a swimming cap." 


At this point, the student should inform you that you have otitis externa, explaining what this is, what causes it and how to manage it. 

The student should be advised on pain management and when to seek further medical attention. If they do not, prompt them by asking: 

  • “What can I do to manage the pain and itching?” 

  • “What causes this?” 

  • “How can I prevent it from happening again?” 

 

 

 

 

Mark Scheme

 
Introduction 
0 / 2
Introduce yourself with an appropriate greeting
+1
Confirm patient details: Name and age
+1
Medical History 
0 / 12
Ask about the patient’s symptoms:
Confirms symptoms started 3 days ago
+1
Pain in left ear
+1
Itching in left ear
+1
No discharge
+1
Enquires if patient has used anything to relieve symptoms or make them worse
+1
Confirms important negatives:
No fever
Fever may indicate an infection.
No hearing loss
This would require further investigation to determine the cause.
No recent infection or trauma to the ear
Trauma may indicate damage to the ear.
Confirmed the patient has recently returned from holiday, where he was frequently swimming without earplugs/swimming caps.
+1
Confirms patient past medical history
+1
Confirms medication history including dose, frequency, indication, including any over-the-counter products and herbal remedies 
+1
Check for allergies
+1
Diagnosis
0 / 2
States the correct diagnosis: Otitis Externa 
+1
Explains the diagnosis in a patient-friendly manner  
+1
E.g. it looks like you have otitis externa, which is an infection of your ear canal. This may have been caused by water irritation in the ear.
Advice 
0 / 4
Self-care/prevention of recurrence (Maximum 4 marks awarded):
Advises that the infection should self-resolve even without medication within a week
Keep the ears clean and dry 
Avoid swimming and water sports for at least 7-10 days
Wear a tightly fitting cap or use earplugs when swimming
Keep shampoo and water out of the ear when showering 
Do not insert anything into the ear such as cotton buds
Management
0 / 4
Offers over the counter pain relief (e.g. paracetamol)
+1
Ibuprofen should be avoided in NSAID-sensitive asthmatics!
Offers acetic acid 2% ear drops or spray (e.g. EarCalm spray©)
+1
Morning, evening, and after swimming, showering, or bathing, for a maximum of 7 days 
+1
Advises the patient to see a GP if symptoms do not improve within a week, worsen, or do not resolve after trying ear drops. 
+1
Communication
0 / 6
Knowledge and understanding of the topic are apparent.
+1
Demonstrates appropriate empathy.
+1
Ensure the patient’s understanding.
+1
Signposts to further resources (e.g. NHS website).
+1
Concludes the conversation well by asking if there are any further questions.
+1
The student did not say anything that could harm the patient
+1
This includes but is not limited to, providing incorrect information or medication, misdiagnosing conditions, neglecting to inquire about allergies, making incorrect referrals, or failing to act on red-flag symptoms.
Time Management
0 / 1
Completed the scenario in time and achieved 70% of marks
+1

 

Any criteria marked in red must be met to pass this station.  




red flag Red Flags missed: 3

Total Score
0/
Skills
professionalism 0/2
communication 0/4
information gathering 0/13
patient safety 0/5
diagnostic reasoning 0/2
patient education 0/10
knowledge 0/13
patient-centred care 0/9
decision making 0/4
problem solving 0/4
Time Management 0/1


Please login to save your score.
Referral Criteria

Referral Criteria for Ear Symptoms: 

  

Refer to A&E if: 

  • Severe trauma to the ear: Significant injury to the ear requires immediate assessment and treatment to prevent further damage. 

 

Refer for an urgent GP appointment if: 

  • Earache that does not improve after 3 days: This could indicate an infection that requires medical attention. 

  • Recurrent ear infections: Frequent ear infections may need further investigation to identify the underlying cause. 

  • Presence of fever or chills: These symptoms may suggest a more serious infection that requires prompt evaluation. 

  • Hearing loss or changes in hearing: A sudden or unexplained change in hearing needs further investigation to determine the cause. 

  • Fluid discharge from the ear (pus or watery): This may be a sign of an ear infection that requires treatment. 

References

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