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

3. EARACHE OR OTALGIA

4. 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

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

6. 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

7. PRIMARY OTALGIA PINNA Trauma Haematoma Infected Eczema Frost Bite
Sunburn
Chondrodermatitis nodularis chronica helicis
Infected Basal Cell/Squamaous cell Ca
More painful exposed thin

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

9. 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

10. REEFERRED EAR ACHE Tonsillitis Nasal Polyps Mumps Thyroid disease’s
Laryngitis
Long Styloid Process
Dental Abnormalities
Oral Ulceration
TMJ Disordres

11. IMPACTED WAX Normal secretion of ceruminous glands Cause of impaction
Pain, deafness, tinnitus,
Removal
Prevention

12. EAR WAX

14. 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

15. FURUNCLE

16. FURUNCLE

17. FURUNCLE

18. 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

19. 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

20. MALIGNANT OTITIS EXTERNA
Progressive infection of meatus, surrounding soft tissue and skull base
Causative Organism
Pseudomonas aeroginosa
Predisposing Factors
Elderly diabetics
Immunocompromised

21. 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

22. HERPES ZOSTER OTICUS

23. 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

24. OTOMYCOSIS

25. 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

26. 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

27. REACTIVE OTITIS EXTERNA

28. ACUTE OTITIS MEDIA

29. 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

30. ACUTE OTITIS MEDIA Managememnt Antibiotics Antipyretics Decongestants
Systemic,Topical
Ear Toilet
Myringotomy
Pain Not responding to above treatmenty
Development of complications
Facial paralysis etc

31. 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.

32. OTITIC BAROTRAUMA

33. 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.

34. ACUTE MASTOIDITIS

35. 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

36. 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.

37. ACUTE TONSILLITIS- referred otalgia

38. PERITONSILLAR ABSCESS- Referred otalgia

39. LARYNGITIS- Referred otalgia

40. THYROID DISEASE- referred otalgia

41. APHTHUS ULCER -Referred otalgia

42. LONG STYLOID PROCESS-Referred otalgia

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