Otalgia: Difference between revisions

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* [[perforated eardrum]]
* [[perforated eardrum]]
* [[Sterile middle ear effusion]]
* [[Sterile middle ear effusion]]
* [[Suppurative otitis media]]  
* Suppurative [[otitis media]]  
* [[Trauma]]
* [[Trauma]]
* [[Tumor]]
* [[Tumor]]

Revision as of 18:37, 28 June 2012

Otalgia
ICD-10 H60 Otitis Externa H65&H66 Otitis Media H92 Otalgia
ICD-9 380.1 Otitis Externa 381 Otitis Media 388.7 Otalgia
DiseasesDB 18027

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]

Synonyms and keywords: ear pain, earache

Overview

Otalgia is ear pain or an earache. Primary otalgia is from pain that originates inside the ear. Referred otalgia is from pain that originates from outside the ear. 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).

Ear pain is usually broken into two categories:

  1. Otitis media (infection/inflammation of the inner ear). In Otitis media, most cases are viral in origin.
  2. Otitis externa: Outer ear canal infection. In Otitis externa, movement of tragus causes pain.

Epidemiology

Otitis Media

  • Male>female
  • Peak incidence is 6-18 months

Risk Factors for Otitis Media

  • Anatomic abnormalities
  • Day care
  • Siblings with otitis media
  • Smoking in household
  • Supine bottles

Complete Differential Diagnosis of Otalgia

(By organ system)

Cardiovascular Acute Coronary Syndrome, Angina
Chemical / poisoning No underlying causes
Dermatologic Eczema, Psoriasis, Furunculosis
Drug Side Effect Reaction to topical agents, Vinflunine, Deferasirox, Ciclesonide, Butorphanol
Ear Nose Throat 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
Endocrine No underlying causes
Environmental Ear Trauma, High altitude sickness, acute barotrauma
Gastroenterologic Esophagitis
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease

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

Viral: Mumps, Varicella, Lymphadenitis, Parotiditis, Sialoadenitis, Herpes Zoster Oticus, Myringitis bullosa, Ramsay Hunt syndrome

Musculoskeletal / Ortho Cervical spine disease, Temporomandibular Joint Dysfunction (TMJ)
Neurologic Trigeminal Neuralgia, Acoustic neuroma, Syphilitic meningitis, Arnold nerve cough syndrome, Glossopharyngeal neuralgia
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Metastatic tumor, Ear tumor, Laryngeal carcinoma, Tongue cancer, Tonsil cancer
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric Functional disorders
Pulmonary No underlying causes
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy Arthritis, Wegener granulomatosis
Sexual No underlying causes
Trauma Cerumen impaction, Cholesteatoma, Head injury, Perforated eardrum
Urologic No underlying causes
Dental Dental caries, Tooth infection
Miscellaneous Post-tonsillectomy/adenoidectomy, Bell palsy, Chondrodermatitis nodularis chronica helicis, Keratosis obturans

In alphabetical order. [1] [2]

Referred Pain

Primary otalgia

Ear pain can be caused by disease in the external, middle, or inner ear, but the three are indistinguishable in terms of the pain experienced.

External ear pain may be:

Middle ear pain may be:

Secondary otalgia

Ear pain can be referred pain to the ears in five main ways:

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.

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.[3]

Laboratory Findings

MRI and CT

  • Head CT scan

Other Diagnostic Studies

Treatment

  • Warm compress
  • Physical therapy, dental bite adjustment (TMJ)
  • Remove foreign bodies with a curette

Pharmacotherapy

Acute Pharmacotherapies

See also

External links

References

  1. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
  3. Amundson L (1990). "Disorders of the external ear". Prim Care. 17 (2): 213–31. PMID 2196606.

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