Otalgia (earache)

Keratosis obturans

a build up of extra skin or flaky skin inside the ear canal • mild ear pain • otorrhea • tinnitus • exam reveals white glistening plug obstructing external meatus

Cerumen Impaction

• blocked, plugged or full sensation • may cause partial hearing loss, itching and possibly dizziness

Trauma

• blows to the head, slaps • puncture ear drum with Q-tip, twigs, pencils • sudden over pressure (explosion)

Frostbite

• burning or tingling pain in the ear followed by numbness • ear appears mottled and gray or white • turns purplish-blue as it warms

Herpes zoster

• burning, stinging ear pain with vesicles • possible hearing loss and/or vertigo • transitory, ipsilateral, facial paralysis • vesicles can appear in other areas of the face including inside the mouth and on the tongue

Secretory Otitis Media

• common in children • effusion may be sterile, or, more commonly, contain pathogenic bacteria • eustachian tube obstruction • initially the TM retracts, altering the light reflex and making the landmarks more visible • eventually a transudate develops in the middle ear, making the TM appear grey or amber • the TM becomes less mobile, contributing to conductive hearing loss • air bubbles or an air-fluid level may be seen behind the TM

Middle Ear Tumor

• deep, boring ear pain and facial paralysis are late signs of malignant tumour, but this is rare in the middle ear

Temporomandibular joint infection

• ear pain referred from the jaw • aggravated by pressure on the joint with jaw movement • usually radiates to the temporal area or the entire side of the head

Dermatitis

• eczema type rashes cause itching, redness, discharge, desquamation, and possibly even fissures • may get secondary infection

Furunculosis

• infected hair follicles in the outer ear canal may produce severe localized ear pain associated with a pus-filled furuncle (boil). • pain < jaw movement • pain > rupture or incision of the furuncle • other symptoms may include: pinna tenderness, swelling of the auditory meatus, partial hearing loss and a feeling of fullness in the ear

Meniere's disease

• inner ear disorder • sensation of fullness • severe vertigo • tinnitus • hearing loss

Trauma

• lacerations, hematomas, fractures of mandible

Otitis externa (acute)

• may be generalized or local • mild to moderate ear pain with tragus manipulation • more common in the summer • low grade fever, possible dizziness and malaise • sticky yellow or purulent ear discharge, often with a foul smell • partial hearing loss • feeling of blockage • later pain intensifies causing the entire side of the head to ache and throb

Perichondritis

• may be initiated by trauma, insect bites, superficial infection of the pinna • pus accumulates between the cartilage and perichondrium • ear pain with warmth and tenderness in the outer ear • reddened dough-like auricle • tends to be long lasting and destructive

Otitis Media (acute)

• most common in young children ages 3 months to 3 years • severe, throbbing ear pain which increases steadily over several hours to days • fullness in ear • mild hearing loss • vague sensation of top heaviness • inflammation may be serous or suppurative • pain aggravated by pressure on the mastoid • fever as high as 40.5C (105F) • slight dizziness, nausea and vomiting may occur • eardrum may be slightly retracted, amber coloured and marked by air bubbles and a meniscus, or may be bulging and red, or eardrum may be blue-black from hemorrhage • before rupture the eardrum appears fiery red • rupture causes purulent discharge and relieves the pain

Barotrauma (Acute

• most common on plane's descent or deep sea dive • mild pressure to severe pain • TM ecchymosis or bleeding into tympanic cavity may occur producing a blue drumhead • TM not usually perforated

Otitis externa (malignant)

• occurs primarily in elderly diabetics or AIDs patients • abrupt ear pain, severe and recurrent • aggravated by moving the auricle or tragus • intense itching • purulent discharge, foul smelling • fever • parotid gland swelling • exam reveals: swollen external canal with exposed cartilage and temporal bone • cranial nerve palsy or paralysis may occur • conductive hearing loss may occur

Extradural abscess

• severe earache with persistent ipsilateral headache, malaise and recurrent mild fever • a complication of middle ear infection

Mastoiditis (acute)

• usually a consequence of acute otitis media • usually begins 2 days to up to 2 weeks after an untreated otitis media • dull ache behind ear • low grade fever • thick purulent discharge in external canal • eardrum is dull and edematous and may be perforated

Ear Canal Obstruction

• usually from an insect or inserted object in a child • severe pain and distressing noise

Myringitis

• vesicles develop on TM during viral infections or acute bacterial infections • sudden onset of pain lasting 24 to 48 hours • hearing loss and fever suggest bacterial otitis media