Otalgia Flashcards
what are the types of otalgia
primary
secondary / referred
what is primary otalgia
pain coming from the ear itself e.g. pinna, external/middle/inner ear
what is secondary/referred otalgia
pain that arises from elsewhere that is supplied by the same nerves
external ear causes of otalgia
otitis externa malignancy necrotising otitis externa perichondritis of the pinna shingles
middle ear causes of otalgia
acute otitis media malingering mastoiditis deep temporal bone erosion trauma
inner ear causes of otalgia
vestibular schwannoma
what is Jacobson’s nerve
Branch of CN IX in middle ear
What is Arnolds nerve
Branch of CN X in EAC
Which nerves can cause referred otlagia
C2,3 CN V CN VII CN IX CN X
causes of C2,3 referred otalgia
arthritis
spondylosis
soft tissue injury
causes of CN V (mandibular) referred otalgia
dental - caries, abscess, impaction
TMJ dysfunction
nasopharyngeal disease: viral, tumour
causes of CN IX referred otalgia
oropharyngeal
- infection: pharyngitis, tonsillitis, quinsy, post tonsillectomy
tongue base tumour
causes of CN VII referred otalgia
sphenoid sinus
palate
history taking for otalgia
Pain - SOCRATES 5 cardinal ear symptoms PMH SH - alcohol, smoking FH
what are the 5 cardinal ear symptoms to ask anyone in an ear history
otalgia discharge hearing loss tinnitus vertigo
what should you assess in otalgia
otoscopy and ear exam
TMJ - feel the joint as patient opens and closes mouth
oral cavity - teeth, tongue
oropharynx
neck - lymph nodes
CN exam - CN VII at least!!! should be full exam
flexible endoscopy - post nasal space, tongue base, pharynx and larynx
management of dental otalgia
chronic pulpitis
tenderness to percusion
dentist / maxfax
NSAIDs, soft diet, dental guard
otalgia associated with TMJ disorder rarely comes from the joint itself, true or false
true, it often comes from the muscles of mastication
cardinal features of TMJ dysfunction
pain around TMJ
trismus
crepitus / cracking
tenderness over joint or associated muscles
drug management of neuralgias
carbamazepine
gabapentin
amitriptyline
list some ENT red flags
hoarse voice
severe pain
weight loss
smoking / alcohol history
investigation for red flags
CT scan
MRI scan
features of neuralgia
severe unilateral pain
