Otalgia

Question 1

Give examples of primary otalgia

Answer 1

affects: external, middle and inner ear, mastoid or tympanic membrane.

Otitis externa
Furuncle
Cerumen, foreign body (including live insects)
Trauma
Herpes zoster
Pericondritis of pinna
Otomycosis
Benign or malignant tumors
Granuloma
Bell’s palsy
Cholesteatoma of external canal
After surgery
Radiation theraphy
Local manifestations of skin disorders (lupus, psoriasis)

Parotid and soft tissue disorders extending into ear canal
Infective otitis media (acute or chronic)
Otitis media with effusion
Chronic otitis media and cholesteatoma
Acute mastoiditis
Benign and malignant tumors
Surgery like application of ventilation tube, myringoplasty, tympanoplasty
Barotrauma
Acute obstruction of Eustachian tube
Trauma

Question 2

Describe what causes referred pain to the ear

Answer 2

Lesions of Pharynx (naso, oro, hypo) pharyngitis
acute tonsillitis (palatine, lingual, pharyngeal)
peritonsillar abscess retropharyngeal abscess
post-adenoidectomy or tonsillectomy
malignant growth

Lesions of Larynx laryngitis
pericondritis and condritis
arthritis of cricoarytenoid joint contact ulcer
malignant growth

Lesions of Oral Cavity and Jaw

Dental neuralgias
exposed dentin, inflamed pulp, unerupted or impacted molars wisdom teeth, traumatic occlusion of teeth faulty jaw closure, improperly fitting denture

TMJ syndrome (COSTEN syndrome)

Acute diffuse glossitis or stomatitis

Carcinoma of oral cavity and tongue
Lesions of Esophagus foreign body hiatus hernia inflammation benign and malignant growth Lesions of Cervical area postauricular lymphadenitis whiplash injury and other cervical spine lesions cervical radiculopathy and arthritis inflammation such as tabes dor

Question 3

Finish the following sentence: If ear examination is normal in an adult with chronic otalgia, the possible diagnosis is ….. until proven otherwise !!!

Answer 3

carcinoma of the head and neck region

Question 4

Descrie the sensory innervation of the ear

Answer 4

Trigeminal nerve (cranial nerve V)
Facial nerve (cranial nerve VII)
Glossopharyngeal nerve (cranial nerve IX)
Vagus nerve (cranial nerve X)
Second and third spinal segments (C2 and C3)

Question 5

Describe the diagnostic workup of a patient suffering from Otalgia

Answer 5

Careful examination of auricle, external ear canal and tympanic membrane
Manual pressure on tragus
Palpation of external canal with a cotton-tipped applicator
Tympanometry
Audiograms
We have to examine head and neck region with rhinoscopy, nasopharyngoscopy, indirect laryngoscopy, upper aerodigestive tract endoscopy

Anamnese: We have to ask suggestive symptoms (like hoarseness, weight loss, dysphagia, odynophagia, nasal obstruction, neck pain, bruxism, toothache, jaw pain, pain with chewing or jaw opening, dyspnea, anorexia, malaise, night sweats, fever)

(obvious caries, malocclusion, missing molars, abscessed teeth, poorly fitting dental prostheses, wear facets on the canins)

TMJ must be palpated with the mouth both closed and widely open

CBC may indicate an occult infection

Thyroid function tests and ESR (erythrocyte sedimentation rate) may reveal thyroiditis and temporal arteritis

Question 6

Describe radiological studies which an be done for otoalgia

Answer 6

Dental radiography

Roentgenography of paranasal sinuses

Roentgenography of cervical spine and chest

Barium swallowing

Panendoscopy

Direct laryngoscopy

Fiberoptic nasopharyngoscopy

CT or MR imaging of skull base, head, temporal bone and neck

Conventional or MR angiography

CT of sinuses

Panorex imagery for TMJ,odontogenic pathology and styloid