Question 1: What side is it?

  • Please document laterality and avoid abbreviations such as 'rt' and 'R'


Question 2: Is there ear discharge?


Question 3: Are the ear canal and tympanic membrane normal on otoscopy? 

  • If yes, then consider referred pain - does the patient have tonsillitis; is there a suspicious lesion in the pharynx; could it be coming from the tempomandibular joint; could it be a type of facial pain or neuralgia?
  • If no, then go to Question 4


Question 4: Is the tympanic membrane opaque, bulging and red? 

  • If yes, then could be acute otitis media if there is associated hearing loss - this is much more common in children
  • If no, then if there are fluid menisci or bubbles behind a dark-looking tympanic membrane with associated hearing loss, this could be otitis media with effusion (glue ear)


For a visual representation, download our Earache flowchart.




Page last reviewed: 23 September 2016