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| {{Infobox_Disease |
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| Name = Otalgia |
| | {{Otalgia}} |
| 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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| {{SI}}
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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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| ==Overview== | | ==[[Otalgia overview|Overview]]== |
| '''Otalgia''' is ''ear pain'' or an ''earache''. Primary otalgia is from [[Pain and nociception|pain]] that originates inside the [[ear]]. Referred otalgia is from pain that originates from outside the ear.
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| Otalgia is not always associated with ear disease. It may be caused by several other conditions, such as impacted teeth, sinus disease, inflamed tonsils and infections in the nose and pharynx. The most common causes of ear pain can be identified though the description of the character, onset, and location (coupled with a physical examination).
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| Ear pain is usually broken into two categories:
| | ==[[Otalgia classification|Classification]]== |
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| #[[Otitis media]] (infection/inflammation of the inner ear). In '''Otitis media''', most cases are viral in origin.
| | ==[[Otalgia pathophysiology|Pathophysiology]]== |
| #[[Otitis externa]]: Outer ear canal infection. In '''Otitis externa''', movement of tragus causes pain.
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| ==Epidemiology== | | ==[[Otalgia causes|Causes]]== |
| '''Otitis Media'''
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| * Male>female
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| * Peak incidence is 6-18 months
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| == Risk Factors for Otitis Media == | | ==[[Otalgia differential diagnosis|Differentiating otalgia from other Diseases]]== |
| * Anatomic abnormalities
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| * Day care
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| * Siblings with otitis media
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| * Smoking in household
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| * Supine bottles
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| ==Complete Differential Diagnosis of Otalgia== | | ==[[Otalgia epidemiology and demographics|Epidemiology and Demographics]]== |
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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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| |- | |
| |-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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| |-
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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 ===
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| * [[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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| [[Category:Signs and symptoms]] | | [[Category:Signs and symptoms]] |
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