Ear pain in children

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Eman Alademi, M.D.[2]

Synonyms and Keywords: Ear pain in kids, earache, ear infection, otitis, ear discomfort, ear sore, otalgia, otodynia.

Historical Perspective

Classification

  • Ear pain in children may be classified according to the anatomic site of er pain :[3]

Other variants of ear pain in children include:[4]

Pathophysiology

Causes

The most common causes of ear pain in children are:[10] is primary otalgia include otitis media and otitis externa[11] include:

1.Diseases of the auricle like: Cellulitis of the auricle, perichondritis,Herpes zoster oticus, local allergic reaction (bug bite), Contact dermatitis, Sunburn, Frostbite.

2.Diseases of the ear canal like: Otitis externa( Bacterial, Fungal, Malignant otitis externa), Furunculosis, Cerumen impaction, foreign bodies, Granuloma,Malignant tumor, Contact dermatitis, Eczema.

3.Diseases of the middle and inner ear like: acute otitis media, eustachian tube dysfunction, Otitis media with effusion, Otitis media with perforation, Otitis media with tympanostomy tubes, myringitis, cholesteatoma, malignant tumor, Complications of otitis media( Mastoiditis, Meningitis, Brain abscess, Venous sinus thrombosis, inner ear infection, Facial nerve palsy).

Less common causes of ear pain in children is secondary otalgia which include:[12] : temporomandibular joint syndrome, pharyngitis, stomatitis, auricular lymphadenopathy or lymphadenitis, sinusitis (maxillary),Parotitis, facial nerve palsy, psychogenic, cervical spine arthritis, and dental infections but it's more common in adults than children[13]. Or traumatic injuries to the ear abrasions or lacerations, auricular hematoma, traumatic perforation of the TM, disruption of the ossicles, hemotympanum (blunt or barotrauma), Basilar skull fracture, associated intracranial injury, Inner ear injury (blunt or barotrauma).

Differentiating ear pain in children from other diseases

Ear pain in children must be differentiated from:[14]

Auricle:[15]

Ear canal:

Middle and inner ear:

Secondary otalgia: [25]

Epidemiology and Demographics

Age

Gender

Race

Risk Factors

Natural History, Complications and Prognosis

Common complications of ear pain (infection) include:[35] [36]

Prognosis is generally good which is resolved symptoms within several days[37][38][39].

Diagnosis

Diagnostic Criteria

Symptoms

Physical Examination

Laboratory Findings

Imaging studies; and consultation with an otolaryngologist[44]

Electrocardiogram

An ECG may be helpful in the diagnosis of carcinoma of the middle ear in children[50]. Findings on an ECG suggestive of carcinoma of the middle ear include atrial dissociation.

X-ray

An x-ray may be helpful in the diagnosis of the inner ear. Findings on an x-ray suggestive of microstructure defects or tumors include otoconia masses, most of the morphology studies of the inner ear[51][52].

Echocardiography or Ultrasound

Echocardiography may be helpful in the diagnosis of carcinoma of the middle ear in children. Findings on an echocardiography suggestive of carcinoma of the middle ear include atrial dissociation[53][54].

CT scan

There are no CT scan findings associated with ear pain in children. However, a CT scan[55] may be helpful in the diagnosis of complications of otitis media in ear pain in children, which include altered mental status in conjunction with cardiovascular instability, fever, focal neurologic findings, meningismus, and severe headache, complications, such as venous sinus thrombosis, meningitis, or brain abscess should be suspected.

MRI

Ear MRI( Magnetic resonance imaging) and referral for nasolaryngoscopymay be helpful in the diagnosis of ear pain in children in the setting of otalgia with normal ear examination findings and symptoms of or risk factors for a tumor[56] . Findings on MRI[57] diagnostic of ear tumor include equal T1 and T2 signals with intensifying in tympanum, and long T1 or equal T1 and long T2 signal in mastoid showed obstructive inflammation.


Other Imaging Findings

There are no other imaging findings associated with ear pain in children.

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

References

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