Ear pain Flashcards
Probability diagnosis
Otitis media (viral or bacterial)
Otitis externa
Boils and furuncles of canal
TMJ arthralgia
Eustachian tube dysfunction
Serious disorders not to be missed
Neoplasia of external ear
Cancer of other sites (e.g. tongue, throat)
Herpes zoster (Ramsay—Hunt syndrome)
Acute mastoiditis
Cholesteatoma
Necrotising otitis externa
Pitfalls (often missed)
Foreign bodies in ear
Hard ear wax
Trauma including barotrauma
Dental abscess
Referred pain: neck, throat (e.g. tonsillitis)
Unerupted wisdom tooth and other dental causes
TMJ arthralgia
Chondrodermatitis nodularis helicus
Facial neuralgias, esp. glossopharyngeal
Post tonsillectomy:
- from the wound
- from TMJ due to mouth gag
Masquerades checklist
Depression
Spinal dysfunction (cervical)
Is the patient trying to tell me something?
Unlikely, but always possible with pain.
More likely in children.
Consider factitious pain.
Key history
Assess the site of pain and radiation, details of the onset of pain, nature of the pain, aggravating or reliving factors
Associated features such as:
- vertigo
- tinnitus
- sore throat
- irritation of the external ear.
Ask about trauma, esp the use of a cotton bud to clean the ear.
Key examination
The external ear with manipulation of the ear
Check helix for chondrodermatitis nodularis helicus
Palpate the face and neck to include the parotid glands, regional lymph nodes, skin and TMJ
Inspect both empty ear canals and tympanic membrane with the auroscope using the largest possible earpiece
Look for causes of referred pain:
- cervical spine
- nose
- postnasal space and
- mouth including teeth
Key investigations
Seldom necessary.
Consider hearing tests, audiometry
Any ear discharge for MC but swabs of no value if the TM is intact
Diagnostic tips
The pain of otitis media may be masked by fever in babies and young children.
If an adult presents with ear pain but normal auroscopy, examine possible referral sites, namely:
- TMJ
- mouth
- throat
- teeth and
- cervical spine.
