Inner Ear Infection

[edash]

I work with (not for!) a fire department who's go-to for any patient that is weak or dizzy is inner ear infection. Their test is to ask the patient to close their eyes and turn their head side to side (like answering 'no'). When the patient says it makes them feel worse, their field diagnosis is inner ear infection. Ever heard of doing this because I haven't.

edash

 

[DrParasite]

never heard of it... also never heard of an inner ear infections being diagnosed in the field. Esp you need antibiotics to get rid of them.

that being said, I have gotten them, and can tell without a doctor looking at me if I have one.

 

[usalsfyre]

Sound like someone witnessed an exam and didn't know what they were looking at. I believe your looking for nystagmus with this test.

Inner ear infection is generally a diagnosis of exclusion. I have no flipping clue why they would be "diagnosing" this in the field.

 

[NYMedic828]

The complaint of feeling "weak and dizzy" is one of the most broad statements out there. The causes are far too numerous to diagnose in the field unless a blatant reason such as hypoglycemia presents itself.

As far as the inner ear thing goes, the inner ear houses the vestibular system which is responsible for maintaining equilibrium, or balance to a degree. The vestibular system is the cause of problems such as motion sickness and whatnot. It is comprised of many sensors that sense both static and dynamically. A malfunction of such, such as an infection can certainly cause symptoms of dizzy/lightheadedness but from an EMS standpoint it simply cannot be considered a practical presumptive diagnosis.

 

[medicsb]

I work with (not for!) a fire department who's go-to for any patient that is weak or dizzy is inner ear infection. Their test is to ask the patient to close their eyes and turn their head side to side (like answering 'no'). When the patient says it makes them feel worse, their field diagnosis is inner ear infection. Ever heard of doing this because I haven't.

edash

I don't recall learning about any maneuver that can be used for the diagnosis of otitis media. A history and physical (including a good otoscopic exam) is required.

 

[edash]

I don't enjoy running calls with this dept. This 'test' they perform is not just one fireman or one crew, it is the bulk of the dept. In their minds, if you call 911 you should be transported by amb to the er, so they try and say anything to convince people to go in by us. Drives me nuts. I figured as much that their test held no water, but I just wanted to make sure.

 

[VFlutter]

Their test is to ask the patient to close their eyes and turn their head side to side (like answering 'no')

I believe your looking for nystagmus with this test.

Testing for nystagmus with the patient's eyes closed? :blink:

 

[Akulahawk]

I don't recall learning about any maneuver that can be used for the diagnosis of otitis media. A history and physical (including a good otoscopic exam) is required.

In all the training I have ever had (and mine goes beyond EMS), I also do not recall learning any single specific maneuver to diagnose an inner ear problem. I'm with you: a good H&P and otoscope is needed for that… and the last time that I checked, using an otoscope was not something that a paramedic was trained to do. Most of the training I have had focused on cerebellar issues rather than the vestibular system. I think that the fire department was looking for a quick and easy way to determine if there was a problem in the inner ear. The idea being that if you shake your head and symptoms get worse, the only system that should have been affected is the vestibular system and inner ear infections can cause dizziness, so they made the logical leap to do what they did.

Another possibility, is that the fire department is looking for a way to get the patient to refuse transport, care, treatment, etc. from them and take themselves to an urgent care center or an emergency department. That would be something that would be very easy to do if you can convince the patient that all they have is an inner ear infection.

I don't necessarily agree with that, especially if the dizziness is a new symptom for the patient.

 

[edash]

Another possibility, is that the fire department is looking for a way to get the patient to refuse transport, care, treatment, etc. from them and take themselves to an urgent care center or an emergency department. That would be something that would be very easy to do if you can convince the patient that all they have is an inner ear infection.

Actually, they are doing this for the opposite reason...they make this "diagnosis" to convince someone to go to the ER by amb.

 

[Cup of Joe]

Actually, they are doing this for the opposite reason...they make this "diagnosis" to convince someone to go to the ER by amb.

I can probably think of 1,000,001 ways to convince the dizzy or weak patient to get in my ambulance before I lie to them with a diagnosis I pulled from left field.

 

[edash]

shooooot..you're telling me.

 

[Veneficus]

I don't recall learning about any maneuver that can be used for the diagnosis of otitis media. A history and physical (including a good otoscopic exam) is required.

Labyrinthitis

Usually causes increased pain or dizziness on the affect side when you have the pt lay flat and turn their head.

Nystagmus is a late sign or in extreme cases.

I have even admitted a case where it was so bad that it caused vagal nerve stimulation and the pt was both bradycardic and hypotensive.