Otorrhea Site Age Type of otorrhea (mucoid,purulent) Characteristic of drainage (acute,pulsatile) Systemic disea ses. Others(otalgia,neurologic deficit)

Ear canal Ear trauma-cotton-tip swabs, irrigators for cerumen removal. Swimming-related water contamination. Chronic dermatitis or eczema Fungal infections. Retained foreign body.

External otitis, Eczema Acute OM with TM perforation Chronic OM Malignant OE Otomycosis Bullous myringitis Herpes zoster oticus

Malignant Otitis Externa. -poor general health. -immunosuppressed. -diabetic -suffering from Steven-Johnson’s syndrome.

Malignant Otitis Externa. -granulation tissue. -preauricular and auricular edema and erythema. -tympanic membrane necrosis. -facial paralysis. -Pseudomonas aeruginosa.

Otomycoses. Aspergillus niger-pigmented fungal with hyphal threads. Candida albicans-prolonged courses of antibiotic ear drops. Secondary mycosis of temporal bone. -Cryptococcus.-Blastomyces -Mucor.- Candida.

Bullous external otitis & myringitis. Hemorrhagic vesicles Exquisite ear pain out of proportion to physical exam. Conductive hearing loss. Mycoplasma pneumoniae & Haemophilus influenzae

Ramsay Hunt syndrome. -vesicles with erythematous base on EAC, pinna, or soft palate. -Otalgia described as a burning sensation. -hearing loss. -vertigo. -facial paralysis.

COM with or without cholesteatoma. Granulomatous diseases of temporal bone (Wegener’s synd. Histiocytosis). Tuberculous mastoiditis. Neoplasms.

Aural tuberculosis & nontuberculous mycobacterial mastoiditis. -chronic painless, thin, watery or serous otorrhea. -denuded malleus and multiple TM perforations -granulation tissue, polyps and inflammatory tissue, diffusely destructive.

Watery otorrhea = CSF leak Idiopathic dural dehiscence. Trauma. Complication of neoplasm, infection. Mondini malformation. Spontaneous CSF leak.

Otalgia Innervation. Anatomy. Causes of referred otalgia.

Tympanic branch of the glossopharyngeal nerve (Jacobson’s nerve) medial surface of TM, mucosa of ME,eustachian tube, mastoid air cells. Cervical roots C2 & C3 –postauricular region Facial N. –skin of lateral concha and antehelix, lobule, mastoid, posterior EAC, posterior pertion of TM

Auriculotemporal branch of the mandibular div. of trigeminal nerve Tragus, anterior pinna, anterior lateral surface of TM, anterosuperior EAC wall. The auricular br. Of vagus N.(Arnold’s nerve) -concha, inferioposterior EAC, TM, postauricular skin. Glossopharyngeal N. –oropharynx, tonsils, tongue base.

Locallized otalgia. Acute otitis media, mastoiditis Otitis externa, impact cerumen. Eustachian tube dysfunction. Inflammation, infection of auricle. Ear trauma.

Referred otalgia Tonsillitis, Tongue diseases. Thyroiditis. Temperomandibular joint arthritis. Periodontal, dental diseases. Parotitis. Sinusitis. Laryngitis, Tracheitis.

Aural fullness Eustachian tube dysfunction. Impact cerumen. Meniere’s disease. Perilymphatic fistula.

Hearing loss Acute (sudden SNHL,viral.) Progressive (autoimmune inner ear Dz, cancer.) Fluctuating (Meniere’s disease, multiple sclerosis.) Systemic diseases. Metabolic Family history. Others.

Hearing loss in children Perinatal infectionwith cytomegalovirus, rubella,syphilis. Family history of hereditary chilhood SNHL. Craniofacial abnormalities. Birth weight < 1,500 gram. Hyperbilirubinemia. Apgar score 0-4 at 1 min., 0-6 at 5 min. Syndromes (Sheibe dysplasia, Michel deformity.)

Vertigo Central VS Peripheral causes. Vestibular dysfunction VS Non vestibular. Trauma to labyrinth. Metabolic (DM, hyperlipoproteinemia, hypothyroidism.) Hormones. Collagen vascular disorders. Tumors.