Ear pain

Whisper Test

at 3 feet away, cover 1 ear of patient and whisper several letters and have patient repeat them. Or watch test-can they hear ticking?

Why is age important for AOM?

decreases after age 6

ROS: EENT

denies difficulty swallowing, hoarseness, pain when open mouth, neck pain, or URI symptoms, or problems with eyes, mouth sinuses, teeth, jaw, throat.

Otolgia

earache

Battle's sign

hemorrhage over mastoid bone may occur with a basal skull fracture

Ménière's disease

usually starts in one ear, but later may involve both. Smoking, infections, or a high-salt diet may worsen the disease. Symptoms include a spinning sensation (vertigo), hearing loss, ear ringing (tinnitus), and ear pressure. The vertigo may cause severe nausea and imbalance. Hearing loss may become permanent

Hx for AOM

-History of Previous AOM -Chronic OM can result in anatomical changes to the TM and middle ear ossicles, predisposing to further infection. -Family History: Siblings or parents with chronic OM, increases a child's risk of OM - Environmental Risks: Smoke exposure Daycare attendance Infant bottle propping -Swimming- increased otitis externa -Airplane travel - barotraumas can be aggravated by recent -URI, failure of the Eustachian tube to open and equilibrate results in collection of fluid in middle ear. - Any Systemic Illness: Diabetes - predisposes to OM and can lead to malignant otitis externa (cellulitis) which requires referral. -History of seborrheic dermatitis or psoriasis - over production of sebum can cause O.E. -History cleft palate - no repaired causes function functional obstruction of Eustachian tubes.

How does loud noise effect hearing?

Destruction of cochlear cells and causes hearing loss.

Palpation of pinna with pain =

EOM

White or dark patches in canal =

Fungal infection

When should you not irrigate the ear?

If Hx suggests perforation

What does Itching Mean?

Itching and drainage usually OE unless the TM has ruptured or from mastoiditis, also herpes zoster with involvement of CN V is a possibility.

Dizziness with hearing loss, vertigo and tinnitus =

Meniere's disease

Etiology of earache

Results from disorders of the external and middle ear. Infection/inflammation, obstruction, or trauma

mastoiditis.

Swelling over mastoid

Temporomandibular Joint Disorders TMJ

(have patient open mouth wide, insert fingertip in ear and pull toward you) as patient opens and closes mouth - pain in 90% of patients with TMJ.

Furuncles

(localized areas of tenderness or swelling) secondary to trauma or irritation.

Pain and the ear

- Pain around outside of ear and with movement of the pinna - Mastoiditis - severe pain over mastoid bone - Bilateral - more likely OE - Unilateral - more likely OM or referred pain - OM - deep pain and blocked ear - SOM - painless or popping, bubbling - OE - tender outer ear - AOM - is severe often can not sleep and relieved suddenly if perforates - TMJ - severe lasts a few minutes, is recurring and associated with a head-ache, worse in AM with teeth grinding. - Trigeminal neuralgia or bells palsy, may have severe ear pain also.

Weber Test

-- 512 HZ or higher tuning fork. place midline on skull. should be equal both ears -- unilateral conductive loss (external or middle ear problem); lateralizes to ear with loss because the better ear will be distracted by ambient noise. -- unilateral sensorneuro loss (inner ear problem); lateralizes to better ear because neural pathway is interrupted on affected side.

Acute Otitis Media (AOM) Pathophysiology

-- as middle ear secretions increase, microbial pathogens grow: commonly streptococcus pnuemonia ( common) -- 60% of children have a fever. A very high fever with otitis is more likely a systemic illness (pneumonia, meningitis). -- U.R.I: If a URI is present the person may have obstruction of the Eustachian tubes causing pain.

cellulitis

A hot red swollen ear

seborrhea

A skin condition that causes scaly patches and red skin, mainly on the scalp; may extend to canal

Rinne Test

AC : BC should be 2:1, if person has a 20 - 30 decibel conductive loss. Bone conduction will be better than air. Place vibrating fork on mastoid process, when patient stops hearing it- move to in front of ear and see if still hears it.

Differential Diagnosis

AOM-severe pain, hearing loss, otorhea, fever, red TM, distorted light reflex, blunted landmarks, Tympanogram-flattened OE- mild to moderate pain with mvt of pinna / tragus, low grade fever, drainage, conductive hearing loss, feels fullness in ear, TM may be red, lymphadenopathy SOM or OM with effusion: bubbling and popping, decreased hearing, mild pain Mastoiditis