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| {{Infobox_Disease |
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| Name = Otalgia |
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| ICD10 = {{ICD10|H|60||h|60}} Otitis Externa {{ICD10|H|65||h|65}}&{{ICD10|H|66||h|65}} Otitis Media {{ICD10|H|92||h|90}} Otalgia |
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| ICD9 = {{ICD9|380.1}} Otitis Externa {{ICD9|381}} Otitis Media {{ICD9|388.7}} Otalgia |
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| ICDO = |
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| Image = |
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| Caption = |
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| OMIM = |
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| MedlinePlus = |
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| eMedicineSubj = |
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| eMedicineTopic = |
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| DiseasesDB = 18027 |
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| }}
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| {{Otalgia}} | | {{Otalgia}} |
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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| {{CMG}} ; '''Associate Editor(s)-in-Chief:''' [[User:Raviteja Reddy Guddeti|Raviteja Guddeti, M.B.B.S.]] [mailto:rgudetti@perfuse.org] | | {{CMG}} ; '''Associate Editor(s)-in-Chief:''' [[User:Raviteja Reddy Guddeti|Raviteja Guddeti, M.B.B.S.]] [mailto:ravitheja.g@gmail.com] {{NE}} |
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| '''''Synonyms and keywords:''''' ear pain, earache | | '''''Synonyms and keywords:''''' Ear pain; earache |
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| | ==[[Otalgia overview|Overview]]== |
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| ==[[Otalgia overview|Overview]]== | | ==[[Otalgia classification|Classification]]== |
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| ==[[Otalgia pathophysiology|Pathophysiology]]== | | ==[[Otalgia pathophysiology|Pathophysiology]]== |
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| ==[[Otalgia epidemiology and demographics|Epidemiology and Demographics]]==
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| ==[[Otalgia risk factors|Risk Factors]]==
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| ==[[Otalgia causes|Causes]]== | | ==[[Otalgia causes|Causes]]== |
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| | ==[[Otalgia differential diagnosis|Differentiating otalgia from other Diseases]]== |
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| ==Complete Differential Diagnosis of Otalgia== | | ==[[Otalgia epidemiology and demographics|Epidemiology and Demographics]]== |
| (Most common causes)
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| * [[Otitis media]]
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| * [[Otitis externa]]
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| * [[Cholesteatoma]]
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| * [[Ear Trauma]]
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| * [[Mastoiditis]]
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| * [[Pharyngitis]]
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| * [[Cerumen impaction]]
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| * [[Perforated eardrum]]
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| * [[Ear canal foreign body]]
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| * [[Dental caries]]
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| | ==[[Otalgia risk factors|Risk Factors]]== |
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| (By organ system)
| | ==[[Otalgia natural history|Natural History, Complications and Prognosis]]== |
| {|style="width:80%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Acute Coronary Syndrome]], [[Angina]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Chemical / poisoning'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"| [[Eczema]], [[Psoriasis]], [[Furunculosis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |bgcolor="Beige"| [[Reaction to topical agents]], [[Vinflunine]], [[Deferasirox]], [[Ciclesonide]], [[Butorphanol]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| Acute [[otitis externa]] (Swimmer's ear), Acute [[otitis media]], [[Auricular perichondritis]], [[Cerumen impaction]], [[Cholesteatoma]], [[Chronic otitis externa]], [[Ear canal foreign body]], [[Eustachian tube]] dysfunction, [[Eustachian tube]] syringitis, [[Furunculosis]], [[Herpes Zoster Oticus]], [[Laryngitis]], Malignant [[otitis externa]], [[Mastoiditis]], [[Myringitis bullosa]], [[Pahryngitis]], [[Retropharyngeal abscess]], [[Rhinitis]], Ruptured or [[perforated eardrum]], [[Sinusitis]], [[Sterile middle ear effusion]], [[Tonsilitis]], [[Tympanostomy tube]] obstruction, [[Acoustic neuroma]], [[Ear Trauma]], Suppurative [[otitis media]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Endocrine'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Environmental'''
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| |bgcolor="Beige"| [[Ear Trauma]], [[High altitude sickness]], acute [[barotrauma]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"| [[Esophagitis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Genetic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"|
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| '''Bacterial:''' Auricular [[erysipelas]], [[Cellulitis]], Cervical [[adenitis]], [[Cervical spine infection]], [[Ear, nose, throat (ENT) deep-space infection]], [[Syphilitic]] [[meningitis]], [[Lymphadenitis]], [[Parotiditis]], [[Sialoadenitis]], [[Furunculosis]], [[Upper respiratory tract infection]]
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| '''Viral:''' [[Mumps]], [[Varicella]], [[Lymphadenitis]], [[Parotiditis]], [[Sialoadenitis]], [[Herpes Zoster Oticus]], [[Myringitis bullosa]], [[Ramsay Hunt syndrome]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Musculoskeletal / Ortho'''
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| |bgcolor="Beige"| [[Cervical spine disease]], [[Temporomandibular Joint Dysfunction]] ([[TMJ]])
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| |bgcolor="Beige"| [[Trigeminal Neuralgia]], [[Acoustic neuroma]], [[Syphilitic]] [[meningitis]], [[Arnold nerve cough syndrome]], [[Glossopharyngeal neuralgia]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Nutritional / Metabolic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Oncologic'''
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| |bgcolor="Beige"| [[Metastatic tumor]], [[Ear tumor]], [[Laryngeal carcinoma]], [[Tongue cancer]], [[Tonsil cancer]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Opthalmologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Overdose / Toxicity'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Psychiatric'''
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| |bgcolor="Beige"| [[Functional disorders]]
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| |- | |
| |-bgcolor="LightSteelBlue"
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| | '''Pulmonary'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Renal / Electrolyte'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Rheum / Immune / Allergy'''
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| |bgcolor="Beige"| [[Arthritis]], [[Wegener granulomatosis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Sexual'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Trauma'''
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| |bgcolor="Beige"| [[Cerumen impaction]], [[Cholesteatoma]], [[Head injury]], [[Perforated eardrum]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dental'''
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| |bgcolor="Beige"| [[Dental caries]], [[Tooth infection]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Miscellaneous'''
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| |bgcolor="Beige"| Post-[[tonsillectomy]]/[[adenoidectomy]], [[Bell palsy]], [[Chondrodermatitis nodularis chronica helicis]], [[Keratosis obturans]]
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| |-
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| |}
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| In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
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| * Acoustic nerve tumor
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| * Acute [[otitis externa]] (Swimmer's ear)
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| * Acute [[otitis media]]
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| * [[Arthritis]] of the [[temporomandibular joint]]
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| * Auricular [[erysipelas]]
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| * Auricular [[perichondritis]]
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| * [[Cellulitis]]
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| * [[Cerumen]] impaction
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| * [[Cervical spine disease]]
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| * [[Cholesteatoma]]
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| * Chronic [[otitis externa]]
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| * [[Chondrodermatitis nodularis chronica helicis]]
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| * Ear canal [[foreign body]]
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| * [[Eczema]]
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| * [[Eustachian tube]] dysfunction
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| * [[Eustachian tube]] syringitis
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| * [[Furunculosis]]
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| * [[Herpes Zoster Oticus]]
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| * [[High altitude sickness]]
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| * [[Keratosis obturans]]
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| * Malignant [[otitis externa]]
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| * [[Mastoiditis]]
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| * [[Mumps]]
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| * [[Myringitis bullosa]]
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| * Other acute [[barotrauma]]
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| * [[Psoriasis]]
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| * [[Ramsay Hunt syndrome]]
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| * Reaction to topical agents
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| * [[perforated eardrum]]
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| * [[Sterile middle ear effusion]]
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| * Suppurative [[otitis media]]
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| * [[Trauma]]
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| * [[Tumor]]
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| * [[Tympanostomy tube]] obstruction
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| * [[Varicella]]
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| * [[Vinflunine]]
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| === Referred Pain === | |
| * [[Acute Coronary Syndrome]]
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| * [[Angina]]
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| * [[Arnold nerve cough syndrome]]
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| * [[Arthritis]]
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| * [[Bell palsy]]
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| * Cervical [[adenitis]]
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| * [[Cervical spine affection]]
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| * [[Dental caries]]
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| * Ear, nose, throat (ENT) deep-space infection
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| * [[Esophagitis]]
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| * [[Functional disorders]]
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| * [[Glossopharyngeal neuralgia]]
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| * [[Laryngeal carcinoma]]
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| * [[Laryngitis]]
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| * [[Lymphadenitis]]
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| * [[Mastoiditis]]
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| * [[Metastatic]] [[tumor]]
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| * [[Mumps]]
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| * [[Pahryngitis]]
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| * [[Parotiditis]]
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| * Post-[[tonsillectomy]]/[[adenoidectomy]]
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| * [[Retropharyngeal]] [[abscess]]
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| * [[Rhinitis]]
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| * [[Sialoadenitis]]
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| * [[Sinusitis]]
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| * [[Syphilitic]] [[meningitis]]
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| * [[Temporomandibular Joint Dysfunction]] ([[TMJ]])
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| * [[Tongue cancer]]
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| * [[Tonsilitis]]
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| * [[Tonsillar cancer]]
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| * [[Tooth infection]]
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| * [[Trigeminal Neuralgia]]
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| * [[Upper respiratory tract infection]]
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| * [[Wegener granulomatosis]]
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| ==Primary otalgia==
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| Ear pain can be caused by disease in the external, [[Middle ear|middle]], or inner ear, but the three are indistinguishable in terms of the pain experienced.
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| '''External''' ear pain may be:
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| * Mechanical: trauma, foreign bodies such as hairs, insects or cotton buds.
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| * Infective (otitis externa): ''[[Staphylococcus]]'', ''[[Pseudomonas]]'', ''[[Candida]]'', [[herpes zoster]], or viral myringitis. (See [[Otitis externa]])
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| '''Middle''' ear pain may be:
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| * Mechanical: [[barotrauma]] (often [[iatrogenic]]), [[Eustachian tube]] obstruction leading to acute [[otitis media]].
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| * Inflammatory / infective: acute otitis media, [[mastoiditis]].
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| ==Secondary otalgia==
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| Ear pain can be referred pain to the ears in five main ways:
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| * Via [[Trigeminal]] nerve [cranial nerve V]. Rarely, trigeminal [[neuralgia]] can cause otalgia.
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| * Via Facial nerve [cranial nerve VII]. This can come from the [[teeth]] (most commonly the upper molars, when it will be worse when drinking cold fluids), the [[temporomandibular]] joint (due to its close relation to the ear canal), or the [[parotid gland]].
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| * Via [[Glossopharyngeal]] nerve [cranial nerve IX]. This comes from the [[oropharynx]], and can be due to [[pharyngitis]] or [[tonsillitis]], or to [[carcinoma]] of the posterior third of the tongue.
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| * Via [[Vagus nerve]] [cranial nerve X]. This comes from the [[laryngopharynx]] in carcinoma of the [[pyriform fossa]] or from the [[esophagus]] in GERD.
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| * Via the second and third [[cervical]] vertebrae, C2 and C3. This ear pain is therefore postural.
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| Psychogenic otalgia is when no cause to the pain in ears can be found, suggesting a functional origin. The patient in such cases should be kept under observation with periodic re-evaluation.
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| ==Diagnosis== | | ==Diagnosis== |
| It is normally possible to establish the cause of ear pain based on the history. It is important to exclude [[cancer]] where appropriate, particularly with unilateral otalgia in an adult who uses [[tobacco]] or [[alcohol]].<ref>{{cite journal | author = Amundson L | title = Disorders of the external ear. | journal = Prim Care | volume = 17 | issue = 2 | pages = 213-31 | year = 1990 | id = PMID 2196606}}</ref>
| | [[Otalgia history and symptoms|History and Symptoms]] | [[ Otalgia physical examination|Physical Examination]] | [[Otalgia laboratory findings|Laboratory Findings]] | [[Otalgia CT|CT]] | [[Otalgia MRI|MRI]] | [[Otalgia other imaging findings|Other Imaging Findings]] | [[Otalgia other diagnostic studies|Other Diagnostic Studies]] |
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| === Laboratory Findings === | | ==Treatment== |
| * [[Complete blood count]] (CBC)
| | [[Otalgia medical therapy|Medical Therapy]] | [[Otalgia interventions|Interventions]] | [[Otalgia surgery |Surgery]] | [[Otalgia primary prevention|Primary Prevention]] | [[Otalgia secondary prevention|Secondary Prevention]] | [[Otalgia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Otalgia future or investigational therapies|Future or Investigational Therapies]] |
| * Culture of otorrhea
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| === MRI and CT ===
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| * Head CT scan
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| === Other Diagnostic Studies ===
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| * [[Tympanometry]]
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| * [[Audiometry]]
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| == Treatment ==
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| * Warm compress
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| * Physical therapy, dental bite adjustment ([[TMJ]])
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| * Remove foreign bodies with a curette
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| === Pharmacotherapy ===
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| ==== Acute Pharmacotherapies ====
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| * Control pain with [[acetaminophen]], nonsteriodal anti-inflammatory drugs ([[NSAIDs]]), and topical [[benzocaine]] solution
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| * Antibiotics ([[otitis media]], [[otitis externa]], [[pharyngitis]] / [[tonsillitis]])
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| * [[NSAIDs]] for [[TMJ]]
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| * Steroid drops, 8% aluminum acetate +/- 2% acetic acid (otitis externa)
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| * Anti[[staphylococcal]] antibiotics, IV anti[[pseudomonal]] (malignant [[otitis externa]])
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| * Decongestants ([[barotrauma]])
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| ==See also==
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| * [[Earwax]]
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| ==External links==
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| *[http://www.seattlechildrens.org/child_health_safety/health_advice/earache.asp What to do if your child has earache] from Seattle Children's Hospital
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| *[http://www.healthbasis.com/ie_content/health%20illustrated%20encyclopedia/1/003046.htm Earaches - Causes, Considerations, Home Care and Prevention] from Healthbasis.com
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| ==References==
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| {{Reflist|2}}
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| {{SIB}}
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| [[it:Otalgia]] | |
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| | == Case Studies == |
| | [[Otalgia case study one|Case #1]] |
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| [[Category:Otolaryngology]] | | [[Category:Otolaryngology]] |
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