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					                 Otalgia



• is ear pain
      or
   an earache.
Otalgia

 otogenic



  nonotogenic
     otalgia


Otogenic or
Primary otalgia
is pain that
originates inside
the ear.
      otalgia

Referred or
secondary otalgia
is pain that
originates from
outside the ear.
          otalgia

The most common causes can be
identified through the
description of the
  character,
  onset, and
  location (coupled with a
physical examination).
otalgia
         Nerve supply


The ear is unique in that no
other structure in the body of
comparable size is supplied by so
many sensory nerves from so
many neural segments
otalgia
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
otalgia
Children with ear infections
are more likely to have acute
otitis media, whereas adults
with ear infections are more
likely to have otitis externa
  External ear pain


Mechanical: trauma, foreign
bodies such as hairs, insects
or cotton buds.
Infective (otitis
externa): Staphylococcus, Ps
eudomonas, Candida, herpe
s zoster, or viral myringitis.
  External ear pain


Acute otitis
externa (Swimmer's ear)
Auricular perichondritis
Cellulitis
Cerumen impaction
Chronic otitis externa
Ear canal foreign body
  External ear pain



Eczema
Furunculosis
Malignant otitis externa
Myringitis bullosa
Psoriasis
Reaction to topical agents
Acute Otitis Externa
        : This is a common cause of
        pain and discharge in the
        adult ear .
        An inflammatory process in
        the canal leads to pain and
        swelling of the external
        meatus itself, which may
        than become so narrowed as
        to become obstructed
Wax

 The canal must be
 around 90% obstructed
 with wax to lead to a
 conductive hearing loss,
 however, wax pressed
 up against the drum
 itself may cause
 deafness and even
 tinnitus and vertigo
 (although this is rare)
Chronic OE
      is less of an infection
      and more of a skin
      disease affecting the
      external ear canal.
      Pain is less
      prominent, and
      sufferers complain of
      itching and blockage
      of the ears.
Other Causes of Otitis Externa

               Viral: Ramsay Hunt
               Syndrome is a Herpes
               Zoster infection of the
               facial nerve. This lead
               to severe otalgia, facial
               palsy and varicelliform
               rash over the pinna.
        Bullous Myringitis

 sporadically occurring viral disease of
the canal and drum. vesicles appear
on the surface of the drum and canal.
There is extreme otalgia and
occasionally a sensorineural hearing
loss, probably because of a viral
neuropathy of the VIIIth cranial
nerve.
     Malignant otitis externa
In diabetics, infection of the canal
with pseudomonas aeruginosa can
lead to an infiltrating infection, which
starts in the ear canal, but invades
bone and can spread across the skull
base, affecting cranial nerves and
become life threatening
  Middle ear pain
Mechanical: barotrauma
(often iatrogenic), Eustachi
an tube obstruction
leading to acute otitis
media.
Inflammatory / infective:
acute otitis
media, mastoiditis.
     Middle ear pain

Acute otitis media
Cholesteatoma
Herpes Zoster Oticus
Mastoiditis
acute barotrauma
Ruptured or perforated eardrum
Sterile middle ear effusion
                Otitis media

Acute otitis media

Acute otitis media
without
effusion (myringitis)

Recurrent otitis media

Otitis Media with Effusion
     MICROBES AT FAULT!!!

Streptococcus pneumoniae
Haemophilus influenzae(non-
typeable)
Moraxella catarrhalis
Group A Streptococcus
Staph aureus
Pseudomonas aeruginosa
RSV assoc. with Acute Otitis
Media
             SIGNS & SYMPTOMS
Neonates/Infants: change in behavior,
  irritability, tugging at ears,
  decreased appetite,
  vomiting.
Children(2-4): otalgia, fever,
   noises in ears, cannot hear
properly,
   changes in personality

Children (>4): complain of ear
  pain, changes in personality
On Physical exam…
        The classic description for
        Otitis Media is an
        erythematic, opaque,
        bulging tympanic membrane
        with loss of anatomic
        landmarks including a
        dull/absent light reflex.
        Pneumatic Otoscopy:
        decreased tympanic
        membrane mobility
      Acute mastoiditis
Definition: an infection of the mastoid
characterized by diffuse osteitis
followed by rarefaction and
breakdown of the bony septae.
   Acute coalescent mastoiditis
   Haemorrhagic mastoiditis
   Masked mastoiditis
Predisposition to pneumatic mastoid
Predilection to kid
 Acute mastoiditis

Symptoms
    Otalgia
    Aural discharge
    Conductive
    hearing loss
    fever
 Acute mastoiditis
Physical findings
   Fever,
   Otorrhea
   Tympanic perforation
   Swelling of the superior TM
   and posterosuperior wall of
   EAC
   Postauricular area
      erythema and tenderness
      Pitting edema
      Obliteration of the
      postauricular crease
          Acute mastoiditis

Radiographic
evaluation
  Diffuse
  rarefaction of
  bone and
  breakdown of
  cellular septae
      Referred
        pain

is an unpleasant
sensation localized to
an area separate from
the site of the
causative injury or
other noxious stimulus
       Referred
    otalgia or pain

is sensed by the ear but
originates from a
nonotologic source poses
a difficult diagnostic
challenge to even the
most experienced
otolaryngologist
Often, referred pain is caused by nerve
compression or irritation.
In this circumstance, the sensation of
pain will generally be felt in the
territory that the nerve serves
(ie,somatic dermatome) even though
the damage originates elsewhere
(ie,visceral tissue).
Is there any Lesson ?


Sympathy of one organ to
other

Nature compels us to
ponder
   Referred
otalgia or pain
      warning


Referred earache
may be a presenting
syptom of head and
neck cancer
 Secondary otalgia



Ear pain can be
referred to the
ears in five main
ways
 Secondary otalgia
Via Trigeminal nerve
 Secondary otalgia
Via Trigeminal nerve
Dental Diseases


Caries tooth
Apical abscess
Impacted molar
Malocclusion
       Migraine

Present with aura
Throbbing unilateral headache
May involve temporals and
post auricular area’s
Accompanied with tinnitus
and auditory hallucinations
Secondary otalgià
   facial nerve
Secondary otalgia
     Secondary otalgia
Via Glossopharyngeal nerve
     Secondary otalgia
Via Glossopharyngeal nerve
Post tonsillectomy pain
   More in adults than
   children
Peritonsillar,
paraphyrangeal and
retropharyngeal abscess
Oral Ulceration

RAS is commonest
oral ulcer
Other causes include
trauma ,Nutritional
deficiency,Bechets
syndrome         and
autoimmune
disorders
Secondary otalgia
 Via Vagus nerve
Secondary otalgia
 Via Vagus nerve
Secondary otalgia
  Via C2 and C3
Secondary otalgia
  Via C2 and C3
     Cervical Spine

C1 C2 C3 nerve roots are
compressed  Pain felt in the
occiput, neck or mastoid area.
Degenerative or infective lesions
    Cervical spondylosis
    Caries spine
The Pinna and lower border of jaw
is affected but not the meatus
depending on the severity and
extent of lesion
Psychogenic otalgia

when no cause to the pain
in ears can be found, it
suggest 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
usestobacco or alcohol.
Laboratory Findings
Complete blood count (CBC)
Culture of otorrhea
MRI and CT
Head CT scan
Other Diagnostic Studies
Tympanometry
Audiometry
TAKE HOME MESSAGE
 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.

				
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