ENT Otolaryngology/ Otorhinolaryngology ENT Head & Neck Surgery Gateways of body Special senses. Taste, hearing, Smell, Balance Narrow cavities. Special.

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