Earache_Common GP presentations Flashcards
DDx of earache?
2 categories
- –Local causes
- –Referred pain (which nerves)
local causes:
Otitis media Otitis externa Boil Referred pain Mastoiditis Herpes zoster Cholesteatoma Otitis media+ effusion Barotruama Haemotoma Foreign body
referred pain:
–Trigeminal nerve (dental abscess/caries, impacted molar teeth, TMj dysfunction); facial nerve (HSV infection, ramsay Hunt syndrome);
–vagus nerve (tumours of the piriform fossa, larynx, or post-cricoid area); (Deep to the mucous membrane of the piriform fossa lie the recurrent laryngeal nerve as well as the internal laryngeal nerve, a branch of the superior laryngeal nerve)
–glossopharyngeal nerve (tonsillitis/quinsy/post-op tonsillectomy, tumour of the base of the tongue or tonsil, neuralgia);
–cervical nerves c2/3 (cervical sponylosis)
specific things to ask for in the history taking of a patient presenting with earache?
Otorrhoea Hearing loss URTI, fever Swimming Headache Pain elsewhere Associated syms Recent antibiotics Steroids Immunodeficiency
what examinations should you do on an earache patient?
General, vitals Outer ear Behind ear Otoscopy Hearing Neck Eyes Cranial nerves lympadenopthy
red flags for an earache patient?
Only 1 hearing ear
Vertigo
Hoarseness
Dysphagia
Meningism
Persistent discharge, perforation, effusion
Recurrent attacks of otitis media in adults
what is ramsay hunt syndrome?
The Ramsay Hunt syndrome occurs when the varicella-zoster virus (chickenpox) becomes reactivated in the geniculate ganglion of the VIIth cranial nerve (facial nerve) causing facial paralysis, loss of taste (anterior 2/3 of the tongue), vestibulocochlear dysfunction and pain
HZO Severe pain, rash, CN VII palsy (geniculate ganglion) Deafness, vertigo Post herpetic neuralgia Anti-viral treatment
list some ototoxic drugs?
antibiotics—- aminoglycosides (very toxic), macrolides (reversible)
salicylates(aspirin)
loop diuretics- furosemide
platimum based anti-cancer drugs- cisplatin, carboplatin
