Otalgia

Dr Tom Leach

8 years ago

Contents

Causes of Otalgia

Local Causes

Causes of Referred Pain

Acute otitis externa

Furunculosis

Barotrauma

Ramsay Hunt Syndrome

Neoplasia

Perichondritis

Myringitis

Children

Adults

Cervical nerves, trigeminal, glossopharyngeal and vagal nerves are involved in referred pain to the ear. Mechanism of referred otalgia;

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)

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)