earache; otalgia
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Etiology
- primary causes
- external ear
- infection
- trauma
- cerumen impaction
- foreign body
- middle ear & mastoid
- otitis media, acute
- 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
- external ear
- secondary causes
- orofacial
- dental infection
- muscle spasm
- sinus pain
- temporomandibular joint (TMJ) syndrome
- visceral branches of cranial nerves IX & X
- trigeminal neuralgia (tic douloreaux)
- multiple sclerosis
- Herpes zoster oticus (Ramsay Hunt syndrome type 2)
- herpetic infection of cranial nerve VII & cranial nerve VIII
- Eagle syndrome (compression of carotid artery by an elongated styloid process)
- orofacial
History
- swimming
- trauma
- upper respiratory tract infection
Clinical manifestations
- earache resolve in 59% of children within 3 days & 90% of children within 7-8 days[2]
- hearing loss
- vertigo
- tympanic membrane appearance:
- light reflex is diffuse to dull in otitis media
- blueish discoloration suggests blood in middle ear
- erythema of auricle: cellulitis; furuncle; external otitis
- altered shape of auricle: mastoiditis
- pain on movement of auricle: otitis externa or media
- ear discharge, generally green or yellow
- tenderness over temporomandibular joint: TMJ syndrome
- swelling & tenderness of parotid or thyroid gland
- tooth pain
Diagnostic procedures
- myringotomy with examination & culture of middle ear effusion
- audiometry to distinguish conductive versus sensory hearing loss
Radiology
- computed tomography (CT) of head
- evaluation for complications of otitis media
Management
- cerumen impaction
- wax softeners
- pulsating irrigation device
- topical agents
- Auralgan (benzocaine & antipyrene) fill ear as needed for pain
- corticosporin otic (polymyxin B, neomycin,hydrocortisone) 4 drops TID/QID
- ciprodex (ciprofloxacin/dexamethasone) or cipro-HC (ciprofloxacin/hydrocortisone)
- Vosol otic (acetic acid, 2%) 3-5 drops BID
- systemic agents
- amoxicillin (Amoxil) 250-500 mg TID 30-50 mg/kg/day divided TID for child
- erythromycin 500 mg BID 30-50 mg/kg/day divided TID/QID for child
- Augmentin 1 tab TID
- pediazole
- cephalosporins
- patient education
More general terms
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 40-42.
- ↑ 2.0 2.1 Thompson M et al Duration of symptoms of respiratory tract infections in children: systematic review. BMJ 2013;347:f7027 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24335668 <Internet> http://www.bmj.com/content/347/bmj.f7027