Earache

Question 1

otalgia

Answer 1

-can occur from:
-otologic causes- ear
-non-otologic causes
-referred pain to: mouth, nasopharynx, tonsils, other parts of URT
-with chronic pain ( > 2-3 weeks), a tumor must be considered particularly in older patients

Question 2

otalgia differential diganosis

Answer 2

-serious otitis media/otitis media with effusion
-acute otitis media
-chronic otitis media- not painful
-otitis externa- very painful
-eustachian tube dysfunction
-barotrauma
-foreign body
-dental infection
-mastoiditis
-trauma
-temporomandibular joint syndrome
-herpes simplex
-chicken pox

Question 3

otitis externa

Answer 3

-earache localized to the canal
-red, swollen
-very painful
-swimmers ear -> dry ears
-risk factors: swimmer, diabetics, mechanical trauma, seborrheic dermatitis
-etiology- pseudomonas, proteus, aspergillus
-may progress with swelling of canal to complete occlusion of ear canal resulting in hearing loss

Question 4

otitis externa signs and symptoms

Answer 4

-erythematous, edematous ear canal
-exquisite tenderness with movement of the tragus
-thick, white, purulent otorrhea
-TM- erythematous, insufflation findings
-very painful
-TESTING- cultures if discharge mainly clinical

Question 5

otitis externa treatment

Answer 5

-keep ear dry
-antibiotics-steroid otic drops- ciproxifan
-wick inserted if severe edema- absorbs fluid
-oral fluoroquinolones- 18+**- can weaken tendons -> advise patients

Question 6

malignant external otitis

Answer 6

-immunocompromised patients susceptible
-persistent otitis externa*- leading to osteomyelitis -> extending to middle ear, base of the skull
-etiology- pseudomonas aeruginosa
-S/S- persistent doul smelling discharge, granulations in ear canal, deep otalgia, CN palsies (6, 7, 9, 10, 11, 12)
-Dx- CT scan- osseous erosion
-treatment- antipseudomonal antibiotics -> long term IV

Question 7

bullous myringitis

Answer 7

-sudden pain
-sometimes hx of herpes
-small blebs on the tympanic membrane
-sometimes herpetic lesions adjacent to tragus
-mycoplasma pneumoniae

Question 8

cerumen impaction

Answer 8

-vague pain accompanied by hearing loss and without other symptoms
-conductive hearing loss- common cause
-visualization
-clean out ear- cerumol; hydrogen peroxide

Question 9

foreign body

Answer 9

-rule out urgently*
-pain or foreign body sensation in involved area
-unilateral otalgia/hearing loss
-sharp or pointy objects may need to be removed with direct visualization
-all FBs in respiratory tract, nose, ear require removal

Question 10

cancer earache

Answer 10

-nasopharynx, pharynx, tonsil, base of tongue, larynx
-often tobacco and/or alcohol use
-sometimes unilateral or remitting middle ear effusion

Question 11

infection earache

Answer 11

-tonsillopharyngitis, peritonsillar, or other oropharyngeal abscess
-pain with swallowing
-pharyngeal erythema and sometimes swelling

Question 12

neurologic earache

Answer 12

-neuralgia (trigeminal, sphenopalatine, glossopharyngeal, geniculate)
-severe, lancinating pain episodes
-PE- none

Question 13

other reasons for earache

Answer 13

-post tonsillectomy or adenoidectomy
-hx of surgery
-PE- varies

Question 14

temporomandibular joint disorder

Answer 14

-S/S:
-pain with jaw movement
-clicking
-lack of smooth temporomandibular joint movement
-trismus- lock jaw
-refer to dentist
-avoid chewing gum and hard foods when experiencing symptoms