An earache is a very common patient presentation, especially in the pediatric population, and a relatively simple problem, such that expert physicians usually are quickly able to arrive at an accurate diagnosis. The earache mind map is organized based upon anatomy. Differentials are divided into external, middle, and internal ear pathologies. This division is not made explicit in the clinical mind map, but diagnoses are listed in the order of the most external to the most internal.
Using the Epi-logical approach, all probable diagnoses must be considered initially. Quick memory recall can be aided by chunking these diagnoses in two different ways. 1) Anatomical categories of outer, middle, internal, and external pathologies or 2) Epidemiological categories of most prevalent, less prevalent, and rare diagnoses. Occasionally, patients come in with an earache as a chief complaint and also have an urgent/emergent situation. An example is a subtle basilar skull fracture. A patient with obvious large skull fracture will present with a different chief complaint, such as altered mental status, and not an earache. A review of vital signs and the patient’s appearance can help identify if an urgent/emergent situation is present. Mastoiditis can be organ-threatening and must be considered under appropriate circumstances. Weighing and removing anchor bias must be done by asking high yield questions and medium yield questions. In addition to history, review of demographics, pertinent risk factors, and physical exam findings help aid in the diagnosis, such that lab tests/imaging are rarely needed.