Causes

Causes of Otalgia
Local Causes
Causes of Referred Pain

Acute otitis externa

Acute otitis media

Furunculosis

Barotrauma

Ramsay Hunt Syndrome

Neoplasia

Perichondritis

Myringitis

Children
Adults
  • Dental disease
  • Temporomandibular joint disease
  • Arthritis: OA or RA
  • Upper respiratory tract infection
  • Sinisitis
  • Spasm of muscles of mastication
  • Cervical spondylosis
  • Upper airway neoplasia
  • Pharyngeal neoplasia

 

Mechanism

Cervical nerves, trigeminal, glossopharyngeal and vagal nerves are involved in referred pain to the ear. Mechanism of referred otalgia;
  • C-spine ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† -> cervical nerves 2 & 3
  • Nose and sinuses¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†->¬†CN V
  • Teeth ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ->¬†CN V
  • Temporomandibular joint ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬†->¬†CN V
  • Oropharynx¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬†->¬†CN IX
  • Larynx ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ->¬†CN X
  • Oesophagus¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ->¬†CN X

Acute otitis externa

  • Common associations with eczema
  • Common after use of cotton buds
  • Common in anything that increases humidity in the ear √† ear phone use, swimming etc.
  • 4 main causative agents; streptococcus, staphylococcus, pseudomonas and fungus (secondary fungal infection is common after initial overuse of antibiotics)
  • Sx; itching and pain
  • O/E; ¬†¬†
    • Red and tender ear canal¬†¬†
    • ¬† Watery discharge¬†¬†
    • ¬† Accumulation of debris + oedema √† hearing loss
  • Rx;¬†¬†
    • Topical antibiotic OR¬†¬†
    • Topical steroid drop OR¬†¬†
    • Antibiotic dressing (if canal severely swollen)¬†¬†
    • 1% hydrocortisone (for itching)

Acute otitis media

  • Causes severe otalgia
  • Upper respiratory tract infection
    • ascends via and blocks Eustachian tube
    • negative pressure in middle ear
    • exudates
    • otitis media with effusion (OME)
  • N.B Mastoiditis is a severe possible complication
  • Sx;¬†¬†
    • Pain (due to pressure in middle ear)
    • Hearing loss
    • ¬† Disharge (if tympanic membrane ruptures) √† reduced pain
    • ¬† Imbalance (especially in adults)
  • O/E;
    • Injected, congested and bulging ear drum
    • Hearing loss
    • Large tonsils ( + adenoids NB cannot see on normal examination of buccal cavity and pharynx)
    • Tympanometry shows no ear movement and produces a flat trace. (Tympanometry measures how the tympanic membrane moves in relation to an applied pressure and thus pressures in the middle ear can be calculated)
  • Rx;
    • NSAIDs and analgesics
    • Systemic broad spectrum antibiotics
    • Decongenstants
    • Myringotomy and grommet insertion (if recurrent)
    • Adenoidectomy (if recurrent)

Ramsay Hunt Syndrome

  • Infection of the facial nerve ganglion by herpes zoster (shingles)
  • NB can cause permanent damage to facial nerve if not treated promptly
  • Sx;
    • Otalgia
    • Facial palsy
    • Hearing loss
    • Imbalanced.¬† O/E;
    • Vesicles in ear canal and around pinnae.¬† Rx;
    • Systemic acyclovir

References

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