Transcript EAR PAIN
EAR PAIN
Auricle
Hematoma
Cellulitis
Relapsing
Polychondritis
Hematoma
A localized mass of extravasated blood
within the auricle- “bruise”
Hematoma
Must be drained to prevent significant
cosmetic deformity
dissolution of supporting cartilagecauliflower ear
Cellulitis
Inflammation of the cellular tissue
May include lobule
Treat with Augmentin or Keflex
Complications- perichondritis and its
resultant deformity
Relapsing Polychondritis
Auricular erythema and edema
Recurrent, frequently bilateral, painful
Does not include lobule- no cartilage
Systematic- may progress to involvement of
the tracheobronchial tree
Treat- Corticosteroids might forestall
cartilage dissolution
External Otitis
Otitis Externa
Otalgia
Pruritus
Purulent discharge
Often recent water exposure or mechanical
trauma
Examination
Erythema
Edema
Purulent exudate
Auricular pain with manipulation
TM- moves normally with pneumatic
otoscopy
Treatment
Avoid moisture
Otic drops containing aminoglycoside
antibiotic and anti-inflammatory
corticosteroid--neomycin sulfate,
polymyxin B sulfate, and hydrocortisone
Ear wick
Auricular Pruritis
Common site- meatus
usually self induced
– excoriation
– overly zealous ear cleaning
Otitis Externa??
Dermatologic condition
– seborrheic dermatitis
– psoriasis
Treatment
Regeneration of Cerumen “blanket”
Avoid drying agents- soap & water, swabs
Mineral oil
0.1% Triamcinolone- topical corticosteroid
Oral antihistamine
Stop messing with it!!!!
Malignant External Otitis
Persistent external otitis
Evolves into Osteomyelitis of the skull base
– Diabetic or Immunocompromised
Pseudomonas aeruginosa
Clinical Findings
Persistent foul aural discharge
Granulation in the ear canal
Deep otalgia
Progressive cranial nerve palsies
– (VI, VII, IX, X, XI, XII)
Diagnosis confirmed with CT
– osseous erosion
Treatment
Prolonged (antipseudomonal) ATB therapy
– IV or Oral ciprofloxacin
Occasional surgical debridement
Serous Otitis Media
Caused by negative pressure
– Blocked auditory tube
– Transudation of fluid
• children- tubes more narrow, more horizontal
• common after URI
• adults- persistent--think cancer
Clinical Findings
Dull, hypomobile TM
Air bubbles in middle ear
Conductive hearing loss
Treatment
Autoinflation
Oral corticosteroids
Oral ATB
All else fails, ventilating tubes
Barotrauma
Negative pressure tends to collapse and lock
the auditory tube
– Rapid altitudinal change
• Air travel
• Scuba diving
Treatment
Swallow, yawn, autoinflate
Systemic or topical decongestants
– pseudoephedrine
– phenylephrine nasal spray
If persists on ground after treatments listed
above…
– Myringotomy provides immediate relief
– Ventilating tubes- frequent flyer
Acute Otitis Media
Bacterial infection of the mucosally lined
air-containing spaces of the temporal bone.
– Usually precipitated by viral URI which causes
auditory tube edema…accumulation of fluid
that becomes secondarily infected with bacteria
– Streptococcus pneumoniae (49%),
Haemophilus influenzae (14%), Moraxella
catarrhalis (14%)
H&P Findings
Otalgia
Aural pressure
Decreased hearing
Fever
erythema
Decreased mobility of TM
TM bulge
– perforation eminent
Treatment
ATB
– amoxicillin
– erythromycin
– sulfonamides
Decongestants
Tympanocentesis
Ventilating tubes
ppx
– sulfamethoxazole
– amoxicillin
Chronic Otitis Media
Chronic infection
Perforation of TM usually present
Mucosal changes
P. aeruginosa, Proteus, Staphylococcus
aureus
Clinical Findings
Hallmark- purulent aural discharge
Pain- on/off
Conductive hearing loss
Treatment
Removal of debris
earplugs to protect against water exposure
ATB drops for exacerbations
Definitive- surgical TM repair
– eliminate infection
– reconstruction of TM
Cholesteatoma*
Special variety of chronic otitis media
Most common cause is prolonged auditory
tube dysfunction, with resultant chronic
negative middle ear pressure that draws
inward the upper flaccid portion of the
tympanic membrane.
*see picture
Cholesteatoma
Creates a squamous epithelium-lined sac
Becomes obstructed and fills with
desquamated keratin and becomes
chronically infected
Typically erodes bone, causes destruction of
nerves, may spread intracranially
Cholesteatoma
Physical examination
– epitympanic retraction pocket or marginal
tympanic membrane perforation that exudes
keratin debris
Treatment
– surgical marsupialization of the sac or its
complete removal
Mastoiditis- complication of OM
Postauricular pain and erythema
Spiking fever
X-ray reveals coalescence of the mastoid air
cells due to destruction of their bony septa
IV ATB and myringotomy for culture and
drainage
Mastoidectomy if other fails...
Petrous apicitis- complication of
OM
Medial portion of the petrous bone between
the inner ear and clivus may become a site
of persistent infection
Foul discharge, deep ear and retro-orbital
pain, and sixth nerve palsy
Prolonged ATB therapy and surgical
drainage
Otogenic skull base osteomylitiscomplication of OM
Osteomyelitis of the skull base
Usually due to P aeruginosa
Facial paralysis- complication of
OM
Acute– Results from inflammation of the nerve in its
middle ear segment, perhaps through bacterially
secreted neurotoxins
• Myringotomy for drainage and culture
• IV ATB
• prognosis excellent
Chronic
– Evolves slowly due to chronic pressure on the
nerve in the middle ear or mastoid by
cholesteatoma
– surgical correction of the underlying disease
– prognosis less favorable
Sigmoid sinus thrombosis complication of OM
Trapped infection within the mastoid air
cells adjacent to the sigmoid sinus may
cause septic thrombophlebitis
Systemic sepsis- spiking fevers, chills
Increased intracranial pressure- HA,
lethargy, nausea and vomiting, papilledema
Diagnosis- MR venography
Tx- IV ATB, surgical drainage
Central Nervous System
Infection - complication of OM
Otogenic meningitis- most common
intracranial complication of ear infection
Non-auditory causes of earache
Temporomandibular joint dysfunction
– chewing (soft foods, massage)
– psychogenic
– dental malocclusion (dental referral)
Glossopharyngeal neuralgia
– refractory to medical management, may
respond to decompression of ninth nerve
Non-auditory causes of earache
Infections and neoplasia that involve the
oropharynx, hypopharynx, and larynx
– persistent earache demands specialty referral to
exclude cancer of the upper aerodigestive tract