Pain in the Ear
what is the valuable sign of otitis media?
absent or diminished motility of the tympanic membrane
What is 'tropical ear'?
acute bacterial otitis
What ear conditions hurt more when you more the pinna?
acute otitis externa, perichondritis
What are the most likely causes of earache in patients?
acute otitis media (77%), otitis external (12%)
which antibiotic do you use for acute otitis media?
amoxycillin (children and adults)
What investigations should you perform on a child with ear problems?
audiometry, tympanometry, and measurement of volume of ear canal. Swabs if discharging (no good if TM is intact), Radiology only if suspect malignancy.
why is knowing about air travel and diving important in ear conditions?
because of barotrauma
List some periotic causes of ear pain
dental cause, upper cervical spinal dysfunction (C2,C3), TMJ arthralgia, parotitis, temporal arteritis, lymph node inflammation
what are the main symptoms in older children?
earache and hearing loss
list some causes of middle ear pain
eustachian insufficiency, eustachian tube dysfunction, barotrauma, acute otitis media, chronic otitis media and cholesteatoma, acute mastoiditis
What are some signs/symptoms of otitis media in children?
fever, irritabiliy, otalgia and otorrhoea. Pulling of ears in infants. 30% need wax removal to see TM
What are some pitfalls (often missed) pains in the ear?
foreign bodies in ear, hard ear wax, barotrauma, dental causes, referred pain: neck, throat, unerupted wisdom tooth, TMJ arthralgia, facial neuralgias, esp glossopharyngeal, Post tonsillectomy: from wound, from TMJ due to mouth gag.
what is bullous myringitis?
haemorrhagic blistering of ear drum or external ear canal. it is an uncommon cause of severe pain. probably caused by influenza
What are the most common causes of ear pain in the elderly?
herpes zoster (ramsay-hunt syndrome), TMJ arthralgia, temporal arteritis, neoplasia.
What may happen to a child with persistent middle ear effusions?
may affect the language and cognitive development of young children.
What are some complications of otitis media in children?
middle ear effusion- if still there after 6-8 weeks redo ABx therapy, if still there after 3 months =ENT, acute mastoiditis- refer, chronic otitis media, serious otitis media (glue ear), rare complications (labyrinthitis, pertrositis, facial paresis and intracranial abscess)
What is recurrent otitis media?
more than every other month or for three or more episodes in 6 months- may needed Abx prevention, consider pneumococcus vaccine in >18 months.
What are some serious causes of ear pain not to missed?
neoplasia of external ear, carcinoma of other sites (e.g. tongue, throat), Herpes zoster (Ramsay hunt syndrome), acute mastoiditis, cholesteatoma, necrotising otitis externa
what are some red flags for painful ear?
offensive discharge >9 days, downward displacement of the pinna, swelling behind ear, neurological symptoms (e.g. headaches, drowsiness), older person: unexplained, intractable ear pain, persistent fever
what is the most common cause of pain in the ear of children?
otitis media
What are the most common causes of ear pain?
otitis media (viral or bacterial), otitis externa, TMJ arthralgia, eustachian tube dysfunction
how can you distinguish between otitis media and otitis externa?
pain on movement of the pinna
List some causes of external ear pain
perichondritis, otitis externa: candida albicans, aspergillus nigra, pseudomonas spp, S.aureus, Furunculosis, trauma, neoplasia, Herpes zoster (Ramsay Hunt syndrome), Viral myringitis, Wax-impacted
What can you do to relieve bullous otitis media?
prick it
what are some important causes of ear pain in children/
primary: otitis media, otitis externa, external canal furuncle or abscess. chronic eczema with fissuring of auricle, impacted wax, foreign body, barotrauma, perchondritis, mastoiditis and bullous myringitis. secondary: pharyngeal lesions, dental problems, gingivostomatitis, mumps and postauricular lymphadenopthy. Peritonsillar abscess (quinsy) may cause ear pain.
When is Abx therapy indicated in a child with painful otitis media?
sick child with fever, vomiting, red-yellow bulging TM, loss of TM landmarks, Persistent fever and pain after 3 days conservative approach
Which organisms are most common in causing otitis media in children
streptococcus penumoniae, Haemophilus influenzae and Moroxella catarrhalis
What features should be noted on a TM?
translucency, colour, position and motility
Give the clinical features of otitis media in children
two peaks of incidence: 6-12 months of age and school entry, seasonal incidence coincides with URTIs, bacteria cause two thirds of cases
where are vesicles most likely to form in herpes zoster of ear? which nerve?
vesicles form in distribution of facial nerve, most notably on posterior wall of ear canal, and around it.
what symptomatic treatment options are there?
warm room, adequate humidity, paracetamol in high dosage, can use nasal decongestants in those with concurrent URTI. Follow up with hearing assessment.
how long should it take the child to improve? how long should the parent wait before going back to the GP?
with appropriate treatment the child should get better in 48 hours. Parents should contact doctor after 72 hours of no improvement. The child should be re-seen at 10 days.
how common are earaches?
1 in 25 patients presenting to GP
what ear condition hurt more when you move their jaw?
TMJ arthralgia, severe otitis externa
