Ear pain resident survival guide

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

Synonyms and keywords:

Overview

Ear pain or otalgia maybe it is the pain that originates outside the ear or the pain that originates from the ear and the etiology can be difficult to establish because of the complex innervation of the ear.otalgia classified as primary which originated from the ear, and secondary which originated outside the ear. When the ear examination is abnormal, the source of the pain from the ear (primary otalgia). When the ear examination is typically normal, the source of the pain is not the ear(secondary otalgia). Secondary otalgia (referred pain) cause is often difficult to determine because the innervation of the ear is complex .

Causes

Life Threatening Causes

Otalgia is not life-threatening, but some characteristics make a serious diagnosis more likely in patients with Otalgia. As patients who are 50 years or older, have coronary artery disease, have diabetes, or are immunocompromised are at higher risk. Also, patients who smoke, drink alcohol, or lose weight unintentionally should undergo more scrutiny.Otalgia may also be the first sign of:-

• temporal arteritis
• Myocardial infarction
• Thoracic aneurysms
• subdural hematoma
• lung cancer
• central line placement
• carotid artery aneurysm
• Pott puffy tumor
• malignant neoplasms

Common Causes

Common causes for Primary Otalgia

• Otitis media
• Otitis externa
• Barotrauma
• Eustachian tube dysfunction
• Foreign object
• Cellulitis of auricle
• Cholesteatoma

Common causes for Secondary Otalgia

• Bell palsy
• Carotidynia
• Cervical adenopathy
• Cervical spine arthritis
• Cricoarytenoid arthritis
• Dental infections
• Gastroesophageal reflux
• Head and neck tumors
• Temporomandibular joint syndrome
• Myofascial pain
• Neuralgias (trigeminal, glossopharyngeal, geniculate, sphenopalatine)
• Oral aphthous ulcers
• Pharyngitis or tonsillitis
• Salivary gland disorders
• Sinusitis
• thyroiditis

Diagnosis

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patient present with history of ear pain

ear examination include:- inspection of the auricle and periauricular region otoscopic examination, which may require cerumen removal. -The tenderness that occurs with traction on the auricle or pressure on the tragus indicates a condition of the external auditory canal, usually otitis externa. -When the ear examination is normal, the physician should palpate the TMJ for tenderness and crepitus as the patient opens and closes the mouth. -In addition, an inspection of the nose and oropharynx, palpation of the head and neck, and an examination of the cranial nerves. -The gingiva should be inspected and palpated and the teeth inspected and percussed to assess tenderness. -Fiberoptic nasolaryngoscopy is not usually necessary. - Patients may need this procedure if they have risk factors for tumor or if conservative measures do not resolve symptoms.

abnormal findings with apperant the causes identified( primary otalgia)

normal or equivocal findings

Treat underlying cause

more evaluation and examine nose, throat, neck, chest(consider audiometry,tympanometry,pneumetic otoscopy)

dental etiology

temporomandibular joint syndrome

Dental referral

pain killer as primary care and soft diet if the pain presistent, refer to dental care

HX of smoking, alcohol use, age older than 50 years,

Coronary artery disease risk factors

HX of headache, malaise, wight loss, fever, or anorexia and age older than 50 years

No risk factors of serious diagnosis

more evaluation by nasolaryngoscopy, tympanometry, audiometry,or magnetic resonance imaging,and computed tomography (if there is a history of cancer, positron emission tomography may be performed to provide)

ECG,chest radiography ,troponin maeseurment

ESR reat

Otolaryngology referral

send to emergency department

depends on the rate of patient more than 50mm per hour immedate otolaryngology or ophthalmology consultation

Observe or treat empirically as pain killer, soft diet * if pain presistent more evaluation and refer

Treatment

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