Ear pain: Difference between revisions
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===Differential Diagnosis=== | ===Differential Diagnosis=== | ||
'''Ear based''' | '''Ear based''' | ||
*[[Otitis media]] - infection of the middle ear. This is the most common cause, the classic ear infection, often caught after going swimming a lot. Commonly seen in children, less common in adults. Can be accompanied by [[hearing loss]]. | *'''[[Otitis media]]''' - infection of the middle ear. This is the most common cause, the classic ear infection, often caught after going swimming a lot. Commonly seen in children, less common in adults. Can be accompanied by [[hearing loss]]. | ||
*[[Otitis externa]] - outer ear inflammation, often cause by [[eczema]]. | *'''[[Otitis externa]]''' - outer ear inflammation, often cause by [[eczema]]. | ||
*Foreign body - kids love to stuff things in their ears. This can cause ear pain, or precipitate infection. | *'''Foreign body''' - kids love to stuff things in their ears. This can cause ear pain, or precipitate infection. | ||
*'''[[Herpes zoster]] - shingles can cause ear pain. | |||
'''Referred pain''' | '''Referred pain''' | ||
*[[Tonsillitis]] | *'''[[Tonsillitis]]''' | ||
*Any cause of [[facial pain]] can present as ear pain, such as [[sinusitis]] and tempero-mandibular joint disorder. | *'''Any cause of [[facial pain]]''' can present as ear pain, such as [[sinusitis]] and tempero-mandibular joint disorder. | ||
*Tenderness of the bone behind the ear could be '''mastoiditis''', a complication of otitis media, where the infection spreads to the bone. Rare now due to [[antibiotic]] use. | |||
*[[Herpes zoster]] | |||
===Investigations=== | ===Investigations=== | ||
With most of these problems, you aren't going to bother with investigations. You will look in the ear, try to visualise the ear drum, and the back of the throat to check for tonsillitis. | |||
===Management=== | ===Management=== | ||
In otitis externa, a mild topical steroid should do the trick. In otitis media, they will probably need antibiotics. There is evidence that it might not do much, but at the moment, chuck 'em some [[amoxicillin]]. | |||
Latest revision as of 14:09, 13 December 2009
Ironically, the cause of this young man's ear ache is sinusitis.
Definition
Epidemiology
VERY common, especially amongst children.
Pathophysiology
There are two causes: pain in the ear, or referred pain from somewhere else.
Clinical and Associated Features
Ear cause
- Hearing loss
- Pus in ear
- Fever
Other cause
- Jaw pain
- Sore throat
- Tenderness on touching bone behind ear
Differential Diagnosis
Ear based
- Otitis media - infection of the middle ear. This is the most common cause, the classic ear infection, often caught after going swimming a lot. Commonly seen in children, less common in adults. Can be accompanied by hearing loss.
- Otitis externa - outer ear inflammation, often cause by eczema.
- Foreign body - kids love to stuff things in their ears. This can cause ear pain, or precipitate infection.
- Herpes zoster - shingles can cause ear pain.
Referred pain
- Tonsillitis
- Any cause of facial pain can present as ear pain, such as sinusitis and tempero-mandibular joint disorder.
- Tenderness of the bone behind the ear could be mastoiditis, a complication of otitis media, where the infection spreads to the bone. Rare now due to antibiotic use.
- Herpes zoster
Investigations
With most of these problems, you aren't going to bother with investigations. You will look in the ear, try to visualise the ear drum, and the back of the throat to check for tonsillitis.
Management
In otitis externa, a mild topical steroid should do the trick. In otitis media, they will probably need antibiotics. There is evidence that it might not do much, but at the moment, chuck 'em some amoxicillin.