“Ear Pain”

Differentials
  • Ear pain caused by EAR PATHOLOGY (working from the outside in):
    • Mastoiditis
      • Ear pain behind the ear – swollen erythematous and tender over the mastoid area, can push the external ear forward
      • Recurrent otitis media, fever, systemically unwell patient
    • Otitis Externa
      • Puritis, otorrhea, tender pinna and tragus
    • Malignant otitis externa
      • Ear pain in an immunocompromised individual, temporal headaches, any associated cranial nerve palsies
    • Acute Otitis Media
      • A swollen tympanic membrane, pyrexia,  malaise +/- discharge
    • Perforated Tympanic membrane
      • Acute pain (and then often relief), hearing loss, recurrent discharge
  • Ear pain caused by an EXTERNAL SOURCE:
    • Oral cavity and tongue cancer
      • An ulcer that doesn’t heal for > 3 weeks. More painful after time.
      • Leucoplakia + erythroplakia of tongue
    • Oropharyngeal cancer
      • Usually, an older patient who is a smoker with a sore throat, a sensation of a lump and referred otalgia
    • Ramsay Hunt Syndrome
      • Triad of LMN facial paralysis, earache and vesicles
    • Cervical Spondylitis
      • Referred neck pain can cause otalgia
Investigations
  1. Otoscopy
  2. Webers and Rinnes test to assess hearing loss (+/- audiometry and tympanometry)
  3. CT if indicated
Management
  • Manage according to the cause

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