Otalgia Common Often difficult to locate cause Beware red flags Children Acute Otitis Media Mastoiditis Teething Otitis externa Usually temporary resolves obvious Children AOM Usually obvious except in early stages ID: 919544
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Slide1
Otalgia
R Lloyd, ENT Consultant, Borough Green ENT Group
Slide2Otalgia
Common
Often difficult to locate cause
Beware red flags
Slide3Children
Acute Otitis Media
Mastoiditis
Teething
??Otitis externa
Usually temporary / resolves / obvious
Slide4Children
AOM
Usually obvious except in early stages
Mastoiditis
Teething
??Otitis externa
Slide5Children
AOM
Mastoiditis
Erythema behind ear => antibiotics, watch
If unwell, or fluctuant swelling behind ear => admit for IVs +/- drainage
Teething
??Otitis externa
Slide6Children
AOM
mastoiditis
Teething
Ear looks normal, slightly pink
??Otitis externa
Slide7Children
AOM
mastoiditis
Teething
??Otitis externa
Less common in children than adults, doesn’t really give rise to acute otalgia, itching is often first symptom
Slide8Adults
Causes:
Ears
Remember it is not always caused by an ear problem!
Slide9Adults
Causes:
Ears
Usually obvious – as for children
Slide10Ears
as a cause of earache
Acute otitis media
Infective otitis externa (common)
Trauma (short-lived)
malignant otitis externa (osteomyelitis of skull base)
Elderly, diabetic, immunocompromised
(Can be fatal)
Nagging, unremitting severe pain, usually some discharge, lower cranial nerve palsies in later stagesRemember: otitis externa/chronic ear infection not responding rapidly to treatment, in elderly diabetic should be referred to ENT urgently
Slide11Referred
otalgia
Causes:
Not ears!
Really really common
Ear looks normal
Upper aero-digestive tract
e.g. cancer of tonsil, pharynx
MusculoskeletalNeuralgice.g. cervical rootDental
Slide12Referred
otalgia
many potential causes.
Remember, if there is no obvious cause in the ear or locally, refer for ENT work up
Slide13Referred otalgia
Local sources
TMJ (v common)
musculoskeletal
Test for TMJ tenderness, or pain with jaw movement
Slide14Referred otalgia
More distant sources
Tonsillitis / pharyngitis
Upper aero-digestive malignancy
?Parotid
Red Flags
Buccal mucosa
Gingiva
Retromolar trigone
Lip
Hard palate
Tongue
Floor of mouth
Tonsil
Slide15Referred otalgia
More distant sources
Tonsillitis / pharyngitis
Upper aero-digestive malignancy
?parotid
Red Flags
Buccal mucosa
Gingiva
Retromolar trigone/floor of mouth
Lip
Hard palate
Tongue
Floor of mouth
Tonsil
Tongue base
Slide16Nerves supplying the ear
C2, 3
(CN VII)
CN V
CN IX
(CN X)
Slide17Referred otalgia
Neuralgia
Eagle’s syndrome
Trigeminal neuralgia
Facial nerve
Occipital neuralgia
Slide18Management
TM and EAC look normal
Referred otalgia
History, any other Symptoms?
Ask about
neck
problems
Ask about
dental
problems
Check
TMJ / oral cavity / tonsils
Palpate the
neck
Treat probable cause (TMJ > neck > teeth)
If no improvement in few weeks refer to ENT
(for
nasendoscopy
etc.)
Slide19