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[1].otalgia classified as primary which originated from the ear, and secondary which originated outside the ear[2]. 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 .[2]
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
Shown below is an algorithm summarizing the diagnosis of [[ear pain]] according the the [...] guidelines.
| patient present with history of ear pain | |||||||||||||||||||||||||||||||||||||||||
| ear examination | |||||||||||||||||||||||||||||||||||||||||
| 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
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
- ↑ Charlett SD, Coatesworth AP (2007). "Referred otalgia: a structured approach to diagnosis and treatment". Int J Clin Pract. 61 (6): 1015–21. doi:10.1111/j.1742-1241.2006.00932.x. PMID 17504363.
- ↑ 2.0 2.1 Earwood JS, Rogers TS, Rathjen NA (2018). "Ear Pain: Diagnosing Common and Uncommon Causes". Am Fam Physician. 97 (1): 20–27. PMID 29365233.