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 Name of nerves

EAR ACHE / OTALGIA Types Primary otalgia Referred otalgia. Refferd pain?

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 More painful exposed thin

PRIMARY OTALGIA Meatus Impacted Wax Keratosis Obturans Boil Otitis Externa Malignant Otitis externa Herpes Zoster Oticus Trauma Wax?

PRIMARY OTALGIA Middle Ear Inner 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 Why out 1/3

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 Predisposing Factors Aspergilis niger, Aspergilis fumigatis, Candida albicans Predisposing Factors Hot & Humid climate Topical antibiotics drops for CSOM or otitis externa

OTOMYCOSIS Clinical Features Treatment 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 Prevention Nasal decongestants Antihistamines Myringotomy Prevention Swallow during descent Donot sleep during descentdecreases 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 Cortical Mastoidectomy 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

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