Ear pain resident survival guide: Difference between revisions

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{{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  
Line 90: Line 90:
* otoscopic examination, which may require cerumen removal. }}
* otoscopic examination, which may require cerumen removal. }}
{{familytree | |,|-|^|-|-|-|-|-|-|.| | }}
{{familytree | |,|-|^|-|-|-|-|-|-|.| | }}
{{familytree | | C01 | | | | | | C02 | C01=abnormal findings with apperant the causes identified( primary otalgia)  | C02=normal or equivocal findings }}
{{familytree | | C01 | | | | | | C02 | C01=abnormal findings with apperant the causes identified( [[primary otalgia]])  | C02=normal or equivocal findings }}
{{familytree | | |!| | | | |,|-|-|-|+|-|-|-|-|.|}}
{{familytree | | |!| | | | |,|-|-|-|+|-|-|-|-|.|}}
{{familytree | | D01 | | | D02 | | D03 | | | D04 |D01=Treat underlying cause|D02=more evaluation and examine nose, throat, neck, chest(consider audiometry,tympanometry,pneumetic otoscopy) |D03=dental etiology|D04=temporomandibular joint syndrome|}}
{{familytree | | D01 | | | D02 | | D03 | | | D04 |D01=Treat underlying cause|D02=more evaluation and examine nose, throat, neck, chest(consider audiometry,tympanometry,pneumetic otoscopy) |D03=dental etiology|D04=[[temporomandibular joint syndrome]]|}}
{{familytree | | | | | | | |!| | | |!| | | | |!| | }}
{{familytree | | | | | | | |!| | | |!| | | | |!| | }}
{{familytree | | | | | | | |!| | | E01 | | | E02|E01=Dental referral|E02=pain killer as primary care and soft diet if the pain presistent, refer to dental care|}}  
{{familytree | | | | | | | |!| | | E01 | | | E02|E01=Dental referral|E02=pain killer as primary care and soft diet if the pain presistent, refer to dental care|}}  
{{familytree | | |,|-|-|-|-|+|-|-|-|v|-|-|-|-|.| }}
{{familytree | | |,|-|-|-|-|+|-|-|-|v|-|-|-|-|.| }}
{{familytree | | F01 | | | F02 | | F03 | | | F04 |F01=HX of smoking, alcohol use, age older than 50 years, |F02=Coronary artery disease risk factors|F03=HX of headache, malaise, wight loss, fever, or anorexia and age older than 50 years |F04=No risk factors of serious diagnosis|}}
{{familytree | | F01 | | | F02 | | F03 | | | F04 |F01=HX of smoking, alcohol use, age older than 50 years, |F02=Coronary artery disease risk factors|F03=HX of [[headache]], [[malaise]], [[wight loss]], [[fever]], or [[anorexia]] and age older than 50 years |F04=No risk factors of serious diagnosis|}}
{{familytree | | |!| | | | |!| | | |!| | | | |!| | | }}
{{familytree | | |!| | | | |!| | | |!| | | | |!| | | }}
{{familytree | | G01 | | | G02 | | G03 | | | |!|G01= 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)|G02=ECG,chest radiography ,troponin maeseurment|G03=ESR reat|}}
{{familytree | | G01 | | | G02 | | G03 | | | |!|G01= 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)|G02=[[ECG]],[[chest radiography]] ,[[troponin]] maeseurment|G03=[[ESR reat]]|}}
{{familytree | | |!| | | | |!| | | |!| | | | |!| | | }}
{{familytree | | |!| | | | |!| | | |!| | | | |!| | | }}
{{familytree | | H01 | | | H02 | | H03 | | | |!|H01=Otolaryngology referral|H02= send to emergency department|H03=depends on the rate of patient more than 50mm per hour immedate otolaryngology or ophthalmology consultation  |}}
{{familytree | | H01 | | | H02 | | H03 | | | |!|H01=Otolaryngology referral|H02= send to emergency department|H03=depends on the rate of patient more than 50mm per hour immedate otolaryngology or ophthalmology consultation  |}}

Revision as of 16:14, 28 October 2020


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,otalgia, earache

Ear pain resident survival guide Microchapters
Overview
Causes
Diagnosis
Treatment


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).[1][2] [3]



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.[1] Also, patients who smoke, drink alcohol, or lose weight unintentionally should undergo more scrutiny.Otalgia may also be the first sign of[2]:-

Common Causes

Common causes for Primary Otalgia

Common causes for Secondary Otalgia[2]

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.[2]

 
 
 
 
 
 
 
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 Keratosis obturans.
  • 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 Earwood JS, Rogers TS, Rathjen NA (2018). "Ear Pain: Diagnosing Common and Uncommon Causes". Am Fam Physician. 97 (1): 20–27. PMID 29365233.
  2. 2.0 2.1 2.2 2.3 Ely JW, Hansen MR, Clark EC (2008). "Diagnosis of ear pain". Am Fam Physician. 77 (5): 621–8. PMID 18350760.
  3. Reiss M, Reiss G (1999). "[Differential diagnosis of otalgia]". Schmerz. 13 (6): 392–7. doi:10.1007/s004829900048. PMID 12799915.