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{{SK}}
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[[Ear pain]],[[otalgia]], [[earache]]
 
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Ear pain resident survival guide (pediatrics)#Treatment|Treatment]]
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Ear pain resident survival guide (pediatrics)#Treatment|Treatment]]
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==Overview==
==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).  
[[Ear pain]] or [[otalgia]] maybe it is a 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. Branches of the fifth, seventh, ninth, and tenth cranial nerve along with cervical nerves 1, 2, and 3 all contribute to sensation in the middle ear, external auditory canal, auricle, and peri-auricular tissues. Irritation of any portion of these cranial nerves can result in otalgia<ref name="pmid20736106">{{cite journal| author=Neilan RE, Roland PS| title=Otalgia. | journal=Med Clin North Am | year= 2010 | volume= 94 | issue= 5 | pages= 961-71 | pmid=20736106 | doi=10.1016/j.mcna.2010.05.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20736106  }} </ref>.[[otalgia]] can be the manifestation of myocardial ischemia (ie, an angina equivalent) because the vagus nerve provides sensory innervations for both structures. Intermittent pain is much more likely to be associated, for example, with musculoskeletal conditions as [[temporomandibular joint]] (TMJ) dysfunction and other myofascial pain dysfunction syndromes.[[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 pain source is not the ear(secondary otalgia) <ref name="pmid15025013">{{cite journal| author=Shah RK, Blevins NH| title=Otalgia. | journal=Otolaryngol Clin North Am | year= 2003 | volume= 36 | issue= 6 | pages= 1137-51 | pmid=15025013 | doi=10.1016/s0030-6665(03)00120-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15025013 }} </ref>.Examination should be carried out including inspection of nasal cavity, oral cavity, neck, and possibly the larynx<ref name="pmid20736106">{{cite journal| author=Neilan RE, Roland PS| title=Otalgia. | journal=Med Clin North Am | year= 2010 | volume= 94 | issue= 5 | pages= 961-71 | pmid=20736106 | doi=10.1016/j.mcna.2010.05.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20736106  }} </ref>.
 
 
   
 
==Causes==
==Causes==
===Life Threatening 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:-
[[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:<ref name="pmid15025013">{{cite journal| author=Shah RK, Blevins NH| title=Otalgia. | journal=Otolaryngol Clin North Am | year= 2003 | volume= 36 | issue= 6 | pages= 1137-51 | pmid=15025013 | doi=10.1016/s0030-6665(03)00120-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15025013  }} </ref><ref name="pmid17504363">{{cite journal| author=Charlett SD, Coatesworth AP| title=Referred otalgia: a structured approach to diagnosis and treatment. | journal=Int J Clin Pract | year= 2007 | volume= 61 | issue= 6 | pages= 1015-21 | pmid=17504363 | doi=10.1111/j.1742-1241.2006.00932.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17504363  }} </ref><ref name="pmid18350760">{{cite journal| author=Ely JW, Hansen MR, Clark EC| title=Diagnosis of ear pain. | journal=Am Fam Physician | year= 2008 | volume= 77 | issue= 5 | pages= 621-8 | pmid=18350760 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18350760  }} </ref>


*[[ temporal arteritis]]
*[[Temporal arteritis]]<ref name="pmid30844551">{{cite journal| author=Journeau L, Pistorius MA, Michon-Pasturel U, Lambert M, Lapébie FX, Bura-Riviere A | display-authors=etal| title=Juvenile temporal arteritis: A clinicopathological multicentric experience. | journal=Autoimmun Rev | year= 2019 | volume= 18 | issue= 5 | pages= 476-483 | pmid=30844551 | doi=10.1016/j.autrev.2019.03.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30844551  }} </ref>
*[[Myocardial infarction]]
*[[Myocardial infarction]]<ref name="pmid25638347">{{cite journal| author=Lu L, Liu M, Sun R, Zheng Y, Zhang P| title=Myocardial Infarction: Symptoms and Treatments. | journal=Cell Biochem Biophys | year= 2015 | volume= 72 | issue= 3 | pages= 865-7 | pmid=25638347 | doi=10.1007/s12013-015-0553-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25638347  }} </ref>
*[[Thoracic aneurysms]]
*Thoracic [[aneurysms]]<ref name="pmid16000910">{{cite journal| author=Klein DG| title=Thoracic aortic aneurysms. | journal=J Cardiovasc Nurs | year= 2005 | volume= 20 | issue= 4 | pages= 245-50 | pmid=16000910 | doi=10.1097/00005082-200507000-00008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16000910  }} </ref>
*[[subdural hematoma]]
*[[Subdural hematoma]]<ref name="pmid28937338">{{cite journal| author=Gillett G| title=Subdural Hematoma. | journal=Camb Q Healthc Ethics | year= 2017 | volume= 26 | issue= 4 | pages= 527-529 | pmid=28937338 | doi=10.1017/S0963180117000068 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28937338  }} </ref>
*[[lung cancer]]
*[[lung cancer]]
*[[ central line placement]]
*Central line placement
*[[ carotid artery aneurysm]]
*[[Carotid artery]] [[aneurysm]]<ref name="pmid28502339">{{cite journal| author=Liu Y, Hua Y, Ling C, Lei N, Feng W| title=Atypical Common Carotid Artery Diaphragm With an Accompanying Aneurysm. | journal=Am J Med Sci | year= 2017 | volume= 353 | issue= 5 | pages= 500-501 | pmid=28502339 | doi=10.1016/j.amjms.2016.08.023 | pmc=5812016 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28502339  }} </ref>
*[[ Pott puffy tumor]]
*Pott puffy tumor<ref name="pmid32809624">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=32809624 | doi= | pmc= | url= }} </ref>
*[[malignant neoplasms]]
*[[Malignant neoplasms]]<ref name="pmid30955068">{{cite journal| author=Faria SC, Elsherif SB, Sagebiel T, Cox V, Rao B, Lall C | display-authors=etal| title=Ischiorectal fossa: benign and malignant neoplasms of this "ignored" radiological anatomical space. | journal=Abdom Radiol (NY) | year= 2019 | volume= 44 | issue= 5 | pages= 1644-1674 | pmid=30955068 | doi=10.1007/s00261-019-01930-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30955068  }} </ref>


===Common Causes===
===Common Causes===


'''Common causes for  Primary Otalgia'''
'''Common causes for  Primary Otalgia'''<ref name="pmid18350760">{{cite journal| author=Ely JW, Hansen MR, Clark EC| title=Diagnosis of ear pain. | journal=Am Fam Physician | year= 2008 | volume= 77 | issue= 5 | pages= 621-8 | pmid=18350760 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18350760  }} </ref>


*[[Otitis media]]
*[[Otitis media]]<ref name="pmid12728112">{{cite journal| author=Sarrell EM, Cohen HA, Kahan E| title=Naturopathic treatment for ear pain in children. | journal=Pediatrics | year= 2003 | volume= 111 | issue= 5 Pt 1 | pages= e574-9 | pmid=12728112 | doi=10.1542/peds.111.5.e574 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12728112  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=12967533 Review in: J Fam Pract. 2003 Sep;52(9):673, 676] </ref>
*[[Otitis externa]]
*[[Otitis externa]]
*[[Barotrauma]]
*[[Barotrauma]]
*[[Eustachian tube dysfunction]]
*[[Eustachian tube dysfunction]]
*[[Foreign object]]
*[[Foreign object]]
*[[Cellulitis of auricle]]
*[[Cellulitis]] of [[auricle]]
*[[Cholesteatoma]]
*[[Cholesteatoma]]


'''Common causes for Secondary Otalgia'''<ref name="pmid18350760">{{cite journal| author=Ely JW, Hansen MR, Clark EC| title=Diagnosis of ear pain. | journal=Am Fam Physician | year= 2008 | volume= 77 | issue= 5 | pages= 621-8 | pmid=18350760 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18350760  }} </ref>
'''Common causes for Secondary Otalgia'''<ref name="pmid17504363">{{cite journal| author=Charlett SD, Coatesworth AP| title=Referred otalgia: a structured approach to diagnosis and treatment. | journal=Int J Clin Pract | year= 2007 | volume= 61 | issue= 6 | pages= 1015-21 | pmid=17504363 | doi=10.1111/j.1742-1241.2006.00932.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17504363  }} </ref><ref name="pmid18350760">{{cite journal| author=Ely JW, Hansen MR, Clark EC| title=Diagnosis of ear pain. | journal=Am Fam Physician | year= 2008 | volume= 77 | issue= 5 | pages= 621-8 | pmid=18350760 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18350760  }} </ref>


*[[Bell palsy]]
*[[Bell palsy]]
*[[Carotidynia]]
*[[Carotidynia]]
*[[Cervical adenopathy]]
*[[Adenopathy|Cervical adenopathy]]
*[[Cervical spine arthritis]]
*[[Cervical spine arthritis]]<ref name="pmid18359358">{{cite journal| author=Jaber JJ, Leonetti JP, Lawrason AE, Feustel PJ| title=Cervical spine causes for referred otalgia. | journal=Otolaryngol Head Neck Surg | year= 2008 | volume= 138 | issue= 4 | pages= 479-85 | pmid=18359358 | doi=10.1016/j.otohns.2007.12.043 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18359358  }} </ref>
*[[Cricoarytenoid arthritis]]
*[[Cricoarytenoid arthritis]]
*[[Dental infections]]
*[[Dental infections]]<ref name="pmid17708777">{{cite journal| author=Kim DS, Cheang P, Dover S, Drake-Lee AB| title=Dental otalgia. | journal=J Laryngol Otol | year= 2007 | volume= 121 | issue= 12 | pages= 1129-34 | pmid=17708777 | doi=10.1017/S0022215107000333 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17708777  }} </ref>
*[[Gastroesophageal reflux]]
*[[Gastroesophageal reflux]]
*[[Head and neck tumors]]
*[[Head and neck tumors]]
*[[Temporomandibular joint syndrome]]
*[[Temporomandibular Joint Syndrome|Temporomandibular joint syndrome]]<ref name="pmid25822556">{{cite journal| author=Gauer RL, Semidey MJ| title=Diagnosis and treatment of temporomandibular disorders. | journal=Am Fam Physician | year= 2015 | volume= 91 | issue= 6 | pages= 378-86 | pmid=25822556 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25822556  }} </ref>
*[[Myofascial pain syndrome|Myofascial pain]]
*[[Myofascial pain syndrome|Myofascial pain]]
*[[Neuralgia|Neuralgias (trigeminal, glossopharyngeal, geniculate, sphenopalatine)]]
*[[Neuralgia|Neuralgias (trigeminal, glossopharyngeal, geniculate, sphenopalatine)]]
*[[Oral aphthous ulcers]]
*[[Oral aphthous ulcers]]
*[[Pharyngitis causes|Pharyngitis]] or [[Tonsillitis classification|tonsillitis]]
*[[Pharyngitis causes|Pharyngitis]] or [[Tonsillitis classification|tonsillitis]]
*[[Salivary gland disorders]]
*[[Salivary gland|Salivary gland disorders]]
*[[Sinusitis workup|Sinusitis]]
*[[Sinusitis workup|Sinusitis]]
*[[thyroiditis]]
*[[thyroiditis]]
Line 74: Line 69:
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | A01 | | | A01=patient present with history of [[ear pain]]
{{familytree | | | A01 | | | A01=patient present with history of [[ear pain]]
Pain (factors should be considered location, duration, aggravating factors, alleviating factors, associated symptoms, previous episodes, medical history, smoking status, and alcohol abuse.)
Pain (factors should be considered location, duration, aggravating factors, alleviating factors, associated symptoms, previous episodes, medical history, smoking status, and alcohol abuse.)  
 
'''Symptoms of primary [[otalgia]] such as -'''
'''Symptoms of primary [[otalgia]] such as -'''
* Otorrhea
*Otorrhea
* Tympanic membrane fullness
*Tympanic membrane fullness
* Vertigo
*Vertigo
'''Symptoms of secondary [[otalgia]]'''
'''Symptoms of secondary [[otalgia]]'''
* Pain with chewing  
*Pain with chewing  
* Sinusitis  
*Sinusitis  
* Dental procedures  
*Dental procedures  
* A history of gastroesophageal reflux.  
*A history of gastroesophageal reflux.  
* No hearing loss }}
*No hearing loss }}
{{familytree | | | |!| | | | }}
{{familytree | | | |!| | | | }}
{{familytree | | | B01 | | B01=ear examination  include:-
{{familytree | | | B01 | | B01=ear examination  include:-
Line 106: Line 102:


==Treatment==
==Treatment==
Shown below is an algorithm summarizing the treatment of [[Ear pain]] according the the [[American Family Physician|American Family Phsyician guidelines]].<ref name="pmid18350760">{{cite journal| author=Ely JW, Hansen MR, Clark EC| title=Diagnosis of ear pain. | journal=Am Fam Physician | year= 2008 | volume= 77 | issue= 5 | pages= 621-8 | pmid=18350760 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18350760  }} </ref>
Shown below is an algorithm summarizing the treatment of [[Ear pain]] according the the [[American Family Physician|American Family Phsyician guidelines]].
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | | | | | A01 |A01=patient with ear pain }}  
{{familytree | | | | | | | | A01 |A01=patient with ear pain }}  
Line 116: Line 112:
{{familytree | | | D01 | | | | | | | | D02 |D01=There is  procedural management by a health professional, in addition to antibiotic therapy as:-
{{familytree | | | D01 | | | | | | | | D02 |D01=There is  procedural management by a health professional, in addition to antibiotic therapy as:-


* Removal of impacted desquamated keratin debris in the ear canal in case Keratosis obturans.
* Removal of impacted desquamated keratin debris in the ear canal in case of Keratosis obturat.
* Surgical debridement, Surgical drainage could be required in case of Chronic perichondritis.  
* Surgical debridement, Surgical drainage could be required in case of Chronic perichondritis.  
* When the development of bullae on the tympanic membrane can be punctured to give pain relief.
* When the development of bullae on the tympanic membrane can be punctured to give pain relief.
Line 125: Line 121:


==References==
==References==
<references />
{{Reflist|2}}
[[Category:needs review]]

Latest revision as of 04:01, 31 July 2021


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Samah Obaiah, MD[2]

Synonyms and keywords:

Ear pain resident survival guide Microchapters
Overview
Causes
Diagnosis
Treatment

Overview

Ear pain or otalgia maybe it is a 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. Branches of the fifth, seventh, ninth, and tenth cranial nerve along with cervical nerves 1, 2, and 3 all contribute to sensation in the middle ear, external auditory canal, auricle, and peri-auricular tissues. Irritation of any portion of these cranial nerves can result in otalgia[1].otalgia can be the manifestation of myocardial ischemia (ie, an angina equivalent) because the vagus nerve provides sensory innervations for both structures. Intermittent pain is much more likely to be associated, for example, with musculoskeletal conditions as temporomandibular joint (TMJ) dysfunction and other myofascial pain dysfunction syndromes.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 pain source is not the ear(secondary otalgia) [2].Examination should be carried out including inspection of nasal cavity, oral cavity, neck, and possibly the larynx[1].

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:[2][3][4]

Common Causes

Common causes for Primary Otalgia[4]

Common causes for Secondary Otalgia[3][4]

Diagnosis

Shown below is an algorithm summarizing the diagnosis of Ear pain according to the American Family Physician AFP 2008 guidelines.

 
 
patient present with history of ear pain

Pain (factors should be considered location, duration, aggravating factors, alleviating factors, associated symptoms, previous episodes, medical history, smoking status, and alcohol abuse.)

Symptoms of primary otalgia such as -

  • Otorrhea
  • Tympanic membrane fullness
  • Vertigo

Symptoms of secondary otalgia

  • Pain with chewing
  • Sinusitis
  • Dental procedures
  • A history of gastroesophageal reflux.
  • No hearing loss
 
 
 
 
 
 
 
 
 
 
 
 
 
ear examination include:-
  • inspection of the auricle and periauricular region
  • otoscopic examination, which may require cerumen removal.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 Ear pain according the the American Family Phsyician guidelines.

 
 
 
 
 
 
 
patient with ear pain
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Infection treat with antibiotics topical or systemic, cleaning of the area, and oral analgesics for comfort
 
 
 
 
 
 
 
referred ear pain
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
If no responsed refered to evaluation by otorhinolaryngology, IV antibiotics, and hospital admission.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
There is procedural management by a health professional, in addition to antibiotic therapy as:-
  • Removal of impacted desquamated keratin debris in the ear canal in case of Keratosis obturat.
  • Surgical debridement, Surgical drainage could be required in case of Chronic perichondritis.
  • When the development of bullae on the tympanic membrane can be punctured to give pain relief.
  • Foreign bodies in the ear canal can cause pain and be treated with careful removal.
  • Infected sebaceous cyst is treated with incision and drainage of the cysts, oral antibiotics, and otorhinolaryngology assessment.
 
 
 
 
 
 
 
depends on the underlying cause

References

  1. 1.0 1.1 Neilan RE, Roland PS (2010). "Otalgia". Med Clin North Am. 94 (5): 961–71. doi:10.1016/j.mcna.2010.05.004. PMID 20736106.
  2. 2.0 2.1 Shah RK, Blevins NH (2003). "Otalgia". Otolaryngol Clin North Am. 36 (6): 1137–51. doi:10.1016/s0030-6665(03)00120-8. PMID 15025013.
  3. 3.0 3.1 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.
  4. 4.0 4.1 4.2 Ely JW, Hansen MR, Clark EC (2008). "Diagnosis of ear pain". Am Fam Physician. 77 (5): 621–8. PMID 18350760.
  5. Journeau L, Pistorius MA, Michon-Pasturel U, Lambert M, Lapébie FX, Bura-Riviere A; et al. (2019). "Juvenile temporal arteritis: A clinicopathological multicentric experience". Autoimmun Rev. 18 (5): 476–483. doi:10.1016/j.autrev.2019.03.007. PMID 30844551.
  6. Lu L, Liu M, Sun R, Zheng Y, Zhang P (2015). "Myocardial Infarction: Symptoms and Treatments". Cell Biochem Biophys. 72 (3): 865–7. doi:10.1007/s12013-015-0553-4. PMID 25638347.
  7. Klein DG (2005). "Thoracic aortic aneurysms". J Cardiovasc Nurs. 20 (4): 245–50. doi:10.1097/00005082-200507000-00008. PMID 16000910.
  8. Gillett G (2017). "Subdural Hematoma". Camb Q Healthc Ethics. 26 (4): 527–529. doi:10.1017/S0963180117000068. PMID 28937338.
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