#MedEd #Tweetorial on EAR PAIN
Because I keep seeing antibiotic prescriptions for non-infected ears! 👂🗯️ Hark, #medtwitter:
About half of ear pain is due to the ear itself: otogenic otalgia.
About half of ear pain is due to a problem outside the ear: referred otalgia.
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Because I keep seeing antibiotic prescriptions for non-infected ears! 👂🗯️ Hark, #medtwitter:
About half of ear pain is due to the ear itself: otogenic otalgia.
About half of ear pain is due to a problem outside the ear: referred otalgia.
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Otogenic otalgia is usually otitis externa or otitis media.
Patients with otitis externa ("swimmer's ear") tend to have drainage, and tenderness with moving the auricle.
Their canal will look like this diagram. "Slightly red," no edema, no pus, is not otitis externa.
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Patients with otitis externa ("swimmer's ear") tend to have drainage, and tenderness with moving the auricle.
Their canal will look like this diagram. "Slightly red," no edema, no pus, is not otitis externa.
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Patients with otitis media tend to have reduced hearing. Often they recently had a URI.
Exam findings include bulging or opaque eardrum, reduced tympanic membrane mobility, and conductive hearing loss.
(Don't give drops if TM is intact: how would abx reach the infection?)
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Exam findings include bulging or opaque eardrum, reduced tympanic membrane mobility, and conductive hearing loss.
(Don't give drops if TM is intact: how would abx reach the infection?)
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If it's not OE or OM, think referred otalgia.
Adults have fewer middle ear infections than children; adult otalgia is more frequently referred.
The ear is served by CN V, CN VII, CN IX, CN X, C2, and C3, and pathology affecting any of these nerves can be felt in the ear.
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Adults have fewer middle ear infections than children; adult otalgia is more frequently referred.
The ear is served by CN V, CN VII, CN IX, CN X, C2, and C3, and pathology affecting any of these nerves can be felt in the ear.
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The commonest causes of referred otalgia:
🍴 TMJ syndrome (ask: pain worse with chewing? exam: joint tenderness or clicking)
🦷 Dental disease (ask about teeth and gums)
🤒 Pharyngitis (ask about sore throat)
🦴 Cervical spine arthritis (ask about posterior neck pain)
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🍴 TMJ syndrome (ask: pain worse with chewing? exam: joint tenderness or clicking)
🦷 Dental disease (ask about teeth and gums)
🤒 Pharyngitis (ask about sore throat)
🦴 Cervical spine arthritis (ask about posterior neck pain)
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The most serious cause of referred otalgia, to be ruled out, is head and neck cancer.
Red flags include dysphagia, hoarseness, weight loss, smoking, heavy drinking, and palpable lymph nodes.
If your index of suspicion is high, send them to an ENT for a scope exam.
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Red flags include dysphagia, hoarseness, weight loss, smoking, heavy drinking, and palpable lymph nodes.
If your index of suspicion is high, send them to an ENT for a scope exam.
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