Causes
Causes of Otalgia | |
Local Causes | Causes of Referred Pain |
Furunculosis Barotrauma Ramsay Hunt Syndrome Neoplasia Perichondritis Myringitis | Children
Adults
|
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 à 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 à 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) à 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
