42. Ear pain

Question 1

causes of ear pain (otalgia)

Answer 1

external
- Otitis externa
- Foreign body

middle
- otitis media
- effusion associated with otitis media
- acute mastoiditis

referred pain
- temporomandibular joint (TMJ) arthritis)
- trigeminal neuralgia
- ramsay hunt syndrome
- adenoidectomy, infection or neoplasm

Question 2

epidemiology auricualr haematoma

Answer 2

Auricular haematomas are common in rugby players and wrestlers

Question 3

management auricular haematoma

Answer 3

Prompt treatment is important to avoid the formation of ‘cauliflower ear’.

Management
auricular haematomas need same-day assessment by ENT
incision and drainage has been shown to be superior to needle aspiration

Question 4

features mastoiditis

Answer 4

otalgia: severe, classically behind the ear
there may be a history of recurrent otitis media
fever
the patient is typically very unwell
swelling, erythema and tenderness over the mastoid process
the external ear may protrude forwards
ear discharge may be present if the eardrum has perforated

Question 5

management mastoiditis

Answer 5

IV antibiotics

Question 6

complications mastoiditis

Answer 6

facial nerve palsy
hearing loss
meningitis

Question 7

otitis media with the presence of swelling around the affected ear and displacement

Answer 7

mastoiditis

Question 8

Otitis externa with worsening unrelenting pain despite strong analgesia

Answer 8

malignant otitis externa - rf urgerntly to ENT!

Question 9

management of perforated tympanic membrane caused by barotrauma

Answer 9

no treatment is needed in the majority of cases as the tympanic membrane will usually heal after 6-8 weeks. It is advisable to avoid getting water in the ear during this time

myringoplasty may be performed if the tympanic membrane does not heal by itself

Question 10

why can throat pain be reffered to the ear?

Answer 10

part of the glossopharyngeal nerve (CN IX) innervates the ear explains why a sore throat can give us referred pain to the ear