Transcript earache
ENT
Otolaryngology/ Otorhinolaryngology
ENT Head & Neck Surgery
Gateways of body
Special senses. Taste, hearing, Smell,
Balance
Narrow cavities. Special equipment
Complex anatomy
EARACHE
OR
OTALGIA
Sensory Supply Of the Ear
5th CN - Auriculotemporal branch
1st and 2nd cervical nerves.
9th CN - Jacobson branch
10th CN- Arnold branch
7th CN - Ramsey hunt branch
EAR ACHE / OTALGIA
•
Types
•
•
Primary otalgia
Referred otalgia.
EVALUATION OF OTALGIA
History
Ear symptoms
Nasal symptoms
swallowing disorders
recent trauma
General Symptoms
Examination
Genral physical examination
Complete ENT examination
Rhinoscopy, nasopharyngoscopy, and indirect laryngoscopy.
Palpation of the neck is important to look for thyroid disease
and 1lymphadenopathy
PRIMARY OTALGIA
PINNA
Trauma
Haematoma
Infected Eczema
Frost Bite
Sunburn
Chondrodermatitis nodularis chronica helicis
Infected Basal Cell/Squamaous cell Ca
PRIMARY OTALGIA
Meatus
Impacted Wax
Keratosis Obturans
Boil
Otitis Externa
Malignant Otitis externa
Herpes Zoster Oticus
Trauma
PRIMARY OTALGIA
Middle Ear
Acute Otitis Media
Otitic Barotrauma
Bullous Myringitis
Haemotympanum
Carcinoma
Complicated CSOM
Acute Mastoiditis
Inner Ear
Noise
Tinnitus described as throbbing pain
REEFERRED EAR ACHE
Tonsillitis
Nasal Polyps
Mumps
Thyroid disease’s
Laryngitis
Long Styloid Process
Dental Abnormalities
Oral Ulceration
TMJ Disordres
IMPACTED WAX
Normal secretion of ceruminous glands
Cause of impaction
Pain, deafness, tinnitus,
Removal
Prevention
EAR WAX
FURUNCLOSIS EAR (Boil)
Staphylococal Infection hair follicle of Ext Meatus
Clinical Features
Pain full swelling in outer 1/3rd of ext auditory canal
Discomfort aggravated on movement of jaw
Deafness
Treatment
Aural dressing
Antibiotic & Steroid Cream or icthamol
Antibiotics
Cloxacillin,Flucloxacillin,Cephradine
Analgesics
Most drain spontaneously
Blood Sugar Levels
FURUNCLE
FURUNCLE
FURUNCLE
Diffuse Otitis Externa
Diffuse inflammation of meatal skin
Aetiology
Hot humid climate
Swimmers
Trauma
Unskilled instrumentation
Scratching ear canal with hair pin
Excessive cleaning of ear canal after swimming
Existing CSOM
Causative Organisms
Pseudomonas aeruginosa
Staph.aureus
B.proteus
Diffuse Otitis Externa
Clinical features
Hot burning sensation
Pain
Serous or purulent discharge
Meatal skin is red warm and tender
Cheesy debris in the deep meatus
Treatment
Aural toilet
Aural dressing
Topical antibiotics with steroids
MALIGNANT OTITIS EXTERNA
Progressive infection of meatus, surrounding soft
tissue and skull base
Causative Organism
Pseudomonas aeroginosa
Predisposing Factors
Elderly diabetics
Immunocompromised
MALIGNANT OTITIS EXTERNA
Clinical Features
Excruciating Pain
Granulations in the Ext ear canal
IX, X, XI CN palsies
Intracranial complications
Treatment
I/V Antibiotics high doses 6-8 weeks
Glycemic control
Debridement of devitalized tissue & bone
HERPES ZOSTER OTICUS
HERPES ZOSTER OTICUS
Viral Infection affecting genicualte ganglion of facial
nerve
Clinical Features
Severe otalgia
Vesicular rash on the concha or pinna
VII Nerve Palsy (Ramsay Hunt Synd.)
Treatment
Oral acyclovir
Pain continues months after the rash as post
herpetic neuralgia requiring
Tricyclic antidepressants
OTOMYCOSIS
OTOMYCOSIS
Fungal Infection of ear canal
Aspergilis niger, Aspergilis fumigatis, Candida albicans
Predisposing Factors
Hot & Humid climate
Topical antibiotics drops for CSOM or otitis externa
OTOMYCOSIS
Clinical Features
Itching
pain in ear
Discharge with musty color
Fungal mass looks like Wet piece of filter paper
Treatment
Aural Toilet
Antifungal Agents
Clotrimazole
2% salicylic acid in alcohal
REACTIVE OTITIS EXTERNA
ACUTE OTITIS MEDIA
ACUTE OTITIS MEDIA
Acute Infection of middle ear by pyogenic organisms.
Common in infants and children
Bacteriology
Strep.Pneumonae,H INF, Moraxella Catarrhalis
Clinical Features
Otalgia,Fever,Ear discharge
Red Congested buldging TM
Small Perforation with ear discharge
ACUTE OTITIS MEDIA
Managememnt
Antibiotics
Antipyretics
Decongestants
Systemic,Topical
Ear Toilet
Myringotomy
Pain Not responding to above treatmenty
Development of complications
Facial paralysis etc
OTITIC BAROTRAUMA
Non suppurative condition due to failure of
eustacchian tube to maintain middle ear pressure at
ambient atmospheric level
Mechanism
When atmospheric pressure is higher than middle ear
pressure by a critical of 90 mm of hg eustachian tube gets
locked.- -ve pressure in middle ear - retraction of
tympanic membrane-hyperaemia,transudation and
haemorrhage in the middle ear.
OTITIC BAROTRAUMA
OTITIC BAROTRAUMA
Treatment
Nasal decongestants
Antihistamines
Myringotomy
Prevention
Swallow during descent
Donot sleep during descentdecreases swallows Effects opening
of eustachians tube
Autoinflation of tube by valsalva during descent.
ACUTE MASTOIDITIS
Acute Mastoiditis
Inflammation of mucosal lining of antrum and
mastoid air cell system.
Clinical Features
Pain behind the ear
Fever
Ear Discharge
Mastoid tenderness
Ear discharge
Sagging of posterosuperior meatal wall
Swelling over the mastoid
Deafness
Acute Mastoiditis
Antibiotics
Myringotomy
Pus under tension not resolving with medical therapy
Cortical Mastoidectomy
Subpreiosteal abscess
Positive reservoir sign
No change in symptoms after 48 hrs of medical management
Complications
Facial palsy, labrynthitis,intracranial complications.
ACUTE TONSILLITIS- referred otalgia
PERITONSILLAR ABSCESS-
Referred otalgia
LARYNGITIS- Referred otalgia
THYROID DISEASE- referred otalgia
APHTHUS ULCER
-Referred otalgia
LONG STYLOID PROCESS-Referred otalgia
THANKS
you can download detailed version of
this lecture from www.entspecialists.pk