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Otalgia R Lloyd, ENT Consultant, Borough Green ENT Group Otalgia R Lloyd, ENT Consultant, Borough Green ENT Group

Otalgia R Lloyd, ENT Consultant, Borough Green ENT Group - PowerPoint Presentation

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Uploaded On 2022-06-15

Otalgia R Lloyd, ENT Consultant, Borough Green ENT Group - PPT Presentation

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

otalgia otitis externa ear otitis otalgia ear externa referred children teething ent mastoiditis common obvious ears aom tmj floor

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Presentation Transcript

Slide1

Otalgia

R Lloyd, ENT Consultant, Borough Green ENT Group

Slide2

Otalgia

Common

Often difficult to locate cause

Beware red flags

Slide3

Children

Acute Otitis Media

Mastoiditis

Teething

??Otitis externa

Usually temporary / resolves / obvious

Slide4

Children

AOM

Usually obvious except in early stages

Mastoiditis

Teething

??Otitis externa

Slide5

Children

AOM

Mastoiditis

Erythema behind ear => antibiotics, watch

If unwell, or fluctuant swelling behind ear => admit for IVs +/- drainage

Teething

??Otitis externa

Slide6

Children

AOM

mastoiditis

Teething

Ear looks normal, slightly pink

??Otitis externa

Slide7

Children

AOM

mastoiditis

Teething

??Otitis externa

Less common in children than adults, doesn’t really give rise to acute otalgia, itching is often first symptom

Slide8

Adults

Causes:

Ears

Remember it is not always caused by an ear problem!

Slide9

Adults

Causes:

Ears

Usually obvious – as for children

Slide10

Ears

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

Slide11

Referred

otalgia

Causes:

Not ears!

Really really common

Ear looks normal

Upper aero-digestive tract

e.g. cancer of tonsil, pharynx

MusculoskeletalNeuralgice.g. cervical rootDental

Slide12

Referred

otalgia

many potential causes.

Remember, if there is no obvious cause in the ear or locally, refer for ENT work up

Slide13

Referred otalgia

Local sources

TMJ (v common)

musculoskeletal

Test for TMJ tenderness, or pain with jaw movement

Slide14

Referred 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

Slide15

Referred 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

Slide16

Nerves supplying the ear

C2, 3

(CN VII)

CN V

CN IX

(CN X)

Slide17

Referred otalgia

Neuralgia

Eagle’s syndrome

Trigeminal neuralgia

Facial nerve

Occipital neuralgia

Slide18

Management

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