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earache; otalgia
Etiology:
1) primary causes
a) external ear
- infection
- bacterial
- Staphylococcus
- Streptococcus
- Pseudomonas
- Proteus
- Mycoplasma (Bullous myringitis)
- fungal
- Candida
- Aspergillus
- trauma
- cotton-tipped swab
- hairpin
- may be secondary infection
- cerumen impaction
- foreign body
b) middle ear & mastoid
- otitis media, acute
- Haemophilus influenzae
- Streptococcus pneumoniae
- Moraxella catarrhalis
- otitis media, chronic with cholesteoma
- barotrauma: sudden change in pressure as in flying or diving causing acute closure of the eustachian tube with extravasation of blood into the middle ear
- eustachian tube obstruction
- generally secondary to tumor in adults
2) secondary causes
a) orofacial
- dental infection
- muscle spasm
- sinus pain
b) temporomandibular joint (TMJ) syndrome
c) visceral branches of cranial nerves IX & X
- pharyngitis
- tonsillitis
- peritonsillar abscess
d) trigeminal neuralgia (tic douloreaux)
e) multiple sclerosis
f) Herpes zoster oticus (Ramsay Hunt syndrome type 2)
- herpetic infection of cranial nerve VII & cranial nerve VIII
g) Eagle syndrome (compression of carotid artery by an elongated styloid process)
History:
1) swimming
2) trauma
3) upper respiratory tract infection
Clinical manifestations:
1) earache resolve in 59% of children within 3 days & 90% of children within 7-8 days [2]
2) hearing loss
3) vertigo
4) tympanic membrane appearance:
a) light reflex is diffuse to dull in otitis media
b) blueish discoloration suggests blood in middle ear
5) erythema of auricle: cellulitis; furuncle; external otitis
6) altered shape of auricle: mastoiditis
7) pain on movement of auricle: otitis externa or media
8) ear discharge, generally green or yellow
a) external otitis
b) perforated tympanic membrane
9) tenderness over temporomandibular joint: TMJ syndrome
10) swelling & tenderness of parotid or thyroid gland
11) tooth pain
Special laboratory:
1) myringotomy with examination & culture of middle ear effusion
2) audiometry to distinguish conductive versus sensory hearing loss
Radiology:
-> computed tomography (CT) of head
- evaluation for complications of otitis media
- brain abscess, mastoiditis
Management:
1) cerumen impaction
a) wax softeners
1] carbamide peroxide (Debrox) 2-3 drops BID
2] Colace 10 mg/mL 1-2 drops BID
b) pulsating irrigation device
2) topical agents
a) Auralgan (benzocaine & antipyrene) fill ear as needed for pain
b) corticosporin otic (polymyxin B, neomycin,hydrocortisone) 4 drops TID/QID
c) ciprodex (ciprofloxacin/dexamethasone) or cipro-HC (ciprofloxacin/hydrocortisone)
d) Vosol otic (acetic acid, 2%) 3-5 drops BID
3) systemic agents
a) amoxicillin (Amoxil) 250-500 mg TID 30-50 mg/kg/day divided TID for child
b) erythromycin 500 mg BID 30-50 mg/kg/day divided TID/QID for child
c) Augmentin 1 tab TID
d) pediazole
e) cephalosporins
4) patient education
a) peroxide or alcohol drops after swimming & showering
b) ear plugs worn during swimming
Related
ear
General
pain [odyn-]
References
- Saunders Manual of Medical Practice, Rakel (ed),
WB Saunders, Philadelphia, 1996, pg 40-42.
- Thompson M et al
Duration of symptoms of respiratory tract infections
in children: systematic review.
BMJ 2013;347:f7027
PMID: 24335668
http://www.bmj.com/content/347/bmj.f7027