Otalgia
| Otalgia | |
| ICD-10 | H60 Otitis Externa H65&H66 Otitis Media H92 Otalgia |
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| ICD-9 | 380.1 Otitis Externa 381 Otitis Media 388.7 Otalgia |
| DiseasesDB | 18027 |
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Otalgia Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Otalgia On the Web |
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American Roentgen Ray Society Images of Otalgia |
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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:
- Otitis media (infection/inflammation of the inner ear). In Otitis media, most cases are viral in origin.
- 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
(Most common causes)
- Otitis media
- Otitis externa
- Cholesteatoma
- Ear Trauma
- Mastoiditis
- Pharyngitis
- Cerumen impaction
- Perforated eardrum
- Ear canal foreign body
- Dental caries
(By organ system)
In alphabetical order. [1] [2]
- Acoustic nerve tumor
- Acute otitis externa (Swimmer's ear)
- Acute otitis media
- Arthritis of the temporomandibular joint
- Auricular erysipelas
- Auricular perichondritis
- Cellulitis
- Cerumen impaction
- Cervical spine disease
- Cholesteatoma
- Chronic otitis externa
- Chondrodermatitis nodularis chronica helicis
- Ear canal foreign body
- Eczema
- Eustachian tube dysfunction
- Eustachian tube syringitis
- Furunculosis
- Herpes Zoster Oticus
- High altitude sickness
- Keratosis obturans
- Malignant otitis externa
- Mastoiditis
- Mumps
- Myringitis bullosa
- Other acute barotrauma
- Psoriasis
- Ramsay Hunt syndrome
- Reaction to topical agents
- perforated eardrum
- Sterile middle ear effusion
- Suppurative otitis media
- Trauma
- Tumor
- Tympanostomy tube obstruction
- Varicella
- Vinflunine
Referred Pain
- Acute Coronary Syndrome
- Angina
- Arnold nerve cough syndrome
- Arthritis
- Bell palsy
- Cervical adenitis
- Cervical spine affection
- Dental caries
- Ear, nose, throat (ENT) deep-space infection
- Esophagitis
- Functional disorders
- Glossopharyngeal neuralgia
- Laryngeal carcinoma
- Laryngitis
- Lymphadenitis
- Mastoiditis
- Metastatic tumor
- Mumps
- Pahryngitis
- Parotiditis
- Post-tonsillectomy/adenoidectomy
- Retropharyngeal abscess
- Rhinitis
- Sialoadenitis
- Sinusitis
- Syphilitic meningitis
- Temporomandibular Joint Dysfunction (TMJ)
- Tongue cancer
- Tonsilitis
- Tonsillar cancer
- Tooth infection
- Trigeminal Neuralgia
- Upper respiratory tract infection
- Wegener granulomatosis
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:
- Mechanical: trauma, foreign bodies such as hairs, insects or cotton buds.
- Infective (otitis externa): Staphylococcus, Pseudomonas, Candida, herpes zoster, or viral myringitis. (See Otitis externa)
Middle ear pain may be:
- Mechanical: barotrauma (often iatrogenic), Eustachian tube obstruction leading to acute otitis media.
- Inflammatory / infective: acute otitis media, mastoiditis.
Secondary otalgia
Ear pain can be referred pain to the ears in five main ways:
- Via Trigeminal nerve [cranial nerve V]. Rarely, trigeminal neuralgia can cause otalgia.
- 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.
- 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.
- Via Vagus nerve [cranial nerve X]. This comes from the laryngopharynx in carcinoma of the pyriform fossa or from the esophagus in GERD.
- Via the second and third cervical vertebrae, C2 and C3. This ear pain is therefore postural.
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
- Complete blood count (CBC)
- Culture of otorrhea
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
- Control pain with acetaminophen, nonsteriodal anti-inflammatory drugs (NSAIDs), and topical benzocaine solution
- Antibiotics (otitis media, otitis externa, pharyngitis / tonsillitis)
- NSAIDs for TMJ
- Steroid drops, 8% aluminum acetate +/- 2% acetic acid (otitis externa)
- Antistaphylococcal antibiotics, IV antipseudomonal (malignant otitis externa)
- Decongestants (barotrauma)
See also
External links
- What to do if your child has earache from Seattle Children's Hospital
- Earaches - Causes, Considerations, Home Care and Prevention from Healthbasis.com
References
- ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
- ↑ Amundson L (1990). "Disorders of the external ear". Prim Care. 17 (2): 213–31. PMID 2196606.