Earache

Note behavior in children

Young infants non specific signs of irritability, poor feeding, congestion, and fever. Older infants and toddler are irritable, pull on the painful ear or bang their head on affected side.

CT scanning

diagnosing cholesteatoma and congenital syndromes

audiometry

freq. and the intensity of sound than can be perceived. The goal is to test the lowest decibel intensity that can be heard for each frequency testes.

Itching or discharge from the ear usually indicated a -- or -- of the --. Drainage may also be present after --. Cholesteatoma? A perforation of the T.M. also associated with --?

inflammation or infection of the external canal. T.M. ruptures. An epidermal inclusion cyst of the middle ear or mastoid. Foul-smelling discharge may occur.

palpate external ears

mastoid process, pre auricle (enlarged in AOM and OE) and post auricle (extension of infection into mastoid cavity) , anterior and posterior cervical lymph nodes

URI: Organisms are forced up the lumen of the eustachian tube. The mucus creates -- and can serve as a medium for bacterial growth.

mechanical obstruction

in children, inflammation most commonly occurs in the --, adults more often have earache from -- or from --.

middle ear, external ear conditions, referred pain.

the most serious, although least common, cause of referred pain is --, a conditions more common in --.

nasopharyngeal cancer, Asians.

if the physical findings are normal, -- is likely the cause. about 50% of -- is cause by --.

referred pain. referred pain, dental problems

hearing loss associated with dizziness, vertigo, or tinnitus may indicate

serious inner ear condition.

Having a sibling or parent with chronic OM makes it -- for the illness to develop in the child.

twice as likely

Inspect the ear canals

vesicle on the external ear canal and auricle may indicate herpes zoster. Cheesy, green-blue or gray discharge can be seen in OE

Scarring and effusion can cause - and - of the T.M. Myringitis? Bullous myringitis? Chronic OM can lead to --?

whitening and opacification Red, inflamed eardrum without effusion Extremely painful condition of small blisters on the T.M. cause by bacterial OM. Cholesteatoma- cyst like mass behind the ear drum

could this be related to a systemic disease (3)?

1. DM-predisposes adults to malignant otitis externa, which is cellulite involving the ear and surround tissues 2. history of seborrheic dermatitis or psoriasis- chronic inflame. dermatitis from overproduction of sebum can cause OE 3. cleft palate

History & Physical Findings: foreign body or cerumen impaction

Hx: both children and adults have pain or vague sensation or discomfort; decreased hearing PE: visualize foreign body or cerumen; may detect foul odor; conducting hearing loss

History & Physical Findings: cholesteatoma

Hx: hearing loss' recent perforated t.m. PE: pearly white lesion on or behind t.m.

History & Physical Findings: cervical lymphadenitis

Hx: history of cervical node swelling; pain in ear common in children PE: enlarged, tender, cervical lymph nodes; may see early onset of AOM in children

History & Physical Findings: barotrauma

Hx: history of flying, diving; severe pain; hearing loss; sensation of fullness; history of recent nasal congestion PE: retraction of billing t.m.; perforation of t.m.; fluid in canal

History & Physical Findings: trauma

Hx: history or blunt trauma; penetration trauma PE: perforation of t.m.

History & Physical Findings: mastoiditis

Hx: history or recent OM; chronic otitis pain behind ear PE: swelling over mastoid process; fever, palpable tenderness, and erythema over mastoid process

History & Physical Findings: cranial nerves (referred pain)

Hx: history, depending on CN involved PE: test function of CNs V, VII, IX, X; ear examination normal

History & Physical Findings: OE

Hx: more common in adults, especially those with diabetes, ear pickers, or swimmers; bilateral itching; pain PE: discharge; inflamed, swollen external canal; pain with movement of pinna; T.M. normal or not visible.

History & Physical Findings: TMJ disorder

Hx: more common in adults; 50% related to dental problem; discomfort to severe pain; unilateral; pain worse in the morning PE: malocclusion; bruxism; normal external and middle ear structures and function; jaw click; abnormal CN function; ear examination normal

History & Physical Findings: OM with effusion

Hx: more common in children but occurs in adults with recent URI; unilateral pain; sensation of crackling or decreased hearing PE: fluid line or air observed behind t.m.; conductive hearing loss; decreased t.m. mobility

History & Physical Findings: AOM

Hx: most common in children < 6; those with smoke exposure; recent URI; severe or deep pain; unilateral; sensational of fullness PE: red, bulging t.m.; fever; decreased light reflex; opaque t.m.; decrease t.m. mobility

History & Physical Findings: cervical nerves I and II (referred pain)

Hx: pain in skin and muscles of neck and in ear canal PE: dermatome evaluation for cervical nerve involvement

location of pain: OE, mastoiditis, AOM

OE: tenderness around the outer ear in the ear canal that worsens with manipulation of the pinna, bilateral Mastoiditis: severe pain or tenderness over the mastoid bone AOM: unilateral

Onset, timing, duration of the pain: TMJ, dental malocclusion or RA, infant, nocturnal onset

TMJ: severe pain lasting a few minutes and recurring 3-4x per day. Worse in the morning because nighttime teeth grinding. Intermittent, or acute, and it related to trauma or overextension of the mouth. Dental malocclusion or RA: chronic pain Infant: crying when sucking Nocturnal onset of otalgia from developing infection is cause by increased vascular pressure in the reclined position cause the T.M. to bulge and to stimulate pain.

Hearing loss in children

Chronic OM with effusion causes a conductive hearing loss in children

quality of pain: AOM, serous otitis, OE, cerumen impaction

AOM: deep pain or blockage of the ear Serous otitis: painless, described as bubbling, popping, or stuffy sensation OE: tenderness of outer ear, may be itchy Cerumen impaction: milder pain or vague discomfort of stuffed ears

Quantity and Severity of the Pain: AOM, tumor

AOM: severe enough to interfere with sleep and may be suddenly relieved if the eardrum perforates. Tumor: chronic pain that is unresponsive to treatment

What does a history of trauma or injury tell me? 6

1. ear trauma- perforation of the eardrum from blunt/penetrating trauma, barotrauma, cotton tip 2. head trauma- direct injury to the inner ear by fracture of the petrous temporal bone. 3. Cerumen impaction- hearing loss, tinnitus, pressure sensation, vertigo, and infection 4. foreign bodies-ear pain and inflammation 5. insect bites- acute pain and tenderness of the external canal 6. loud noise- high-pitches and loud nose for a prolonged period

environmental conditions that might increase risk 5

1. second hand cig smoke. leads to functional eustachian tube obstruction and decreases the protective ciliary action in the tube 2. attending day care 3. bottle propping 4. swimming 5. airplane travelers, divers-barotrauam, failure of the eustachian tube to open and equilibrate during results in a collection of serosanguineous fluid in the middle ear, may be felt as ear pressure that can lead to pain, tinnitus, and temporary deafness.

infants younger than -- who have their first AOM run a high risk of --.

3 months, recurrence.

the occurrence of AOM declines significantly after age --.

6

fever is present in % of all children with AOM. In infants younger than --, fever with AOM is uncommon. A high fever accompanying otitis is more likely to indicate a systemic illness, such as -- or --.

60%, 2 months, pneumonia, meningitis.

Inspect external ears: Battle sign, eczematous seborrhea or psoriasis, fungal and yeast infection, cellulitis

Battle sign: hemorrhage over the mastoid bone, basal skull fracture eczematous seborrhea or psoriasis: redness and scaling of the skin that can extend into the external ear canal fungal and yeast infection: white or dark patches cellulitis: a hot, swollen, and erythematous ear and surrounding skin

Difficulty hearing can indicate --? -- is usually a condition of adults who have chronic infection that may destroy the ossicles and spread to the mastoid, labyrinth, and intracranial structure causing --. Chronic ear pain is often assoc. with --?

Blockage of the ear canal by cerumen or a foreign body, inflammation of the middle or inner ear, or a neoplasm. Chronic otitis media, hearing loss. Hearing loss and ear discharge secondary to a perforated non-healing T.M.