earache & referred otalgia col shoaib ahmed mbbs (honours) fcps frcs (glasgow) classified ent...

EARACHE &

REFERRED OTALGIA

Col Shoaib Ahmed MBBS (Honours) FCPS FRCS (Glasgow)

Classified ENT Specialist & Head & Neck SurgeonCMH Rawalpindi

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Nerve Supply of Ear

• Richly innervated• Multiple cranial & spinal nerves• Shared nerve supply with other head &

neck sites• Inner ear has no sensory supply

Details of nervesMost of the external ear

• Great auricular nerve (cervical plexus C 2,3)• Auriculo temporal nerve (branch of Vc)

Small contributions from• Auricular branch of X nerve• Somatosensory branch of VII nerve

Middle ear supply• Tympanic branch of IX nerve

Nerve Supply

Greater auricular nerve

Lesser occipital nerve

Nerve supply of pinna

Nerve supply of external auditory canal

Auriculo temporal nerve

Arnold nerve

Great auricular nerve

Otalgia is ear pain

• 2 types• Primary otalgia Pain that arises from a pathology within the

ear (external , middle)• Referred otalgia Pain that originates from outside the ear

Primary otalgia

• Common causes• Infections of pinna• external auditory canal (boil)• middle ear / mastoid (otitis

media, mastoiditis)• Neoplasms of external & middle ear

Referred Pain

• Pain felt at a site different from the location of the injured or diseased part of the body

• Nerve signals from several areas of the body may "feed" the same nerve pathway leading to the spinal cord and brain

• EXAMPLES• Pain of coronary artery insufficiency • Gall bladder pain• Appendix• Liver

Why referred otalgia occurs ?

• Irritation of the large array of nerves their distant branches

↓Cause perception of pain within the ear

When to label as referred otalgia ?

• CLINICALLY NORMALPinnaExternal auditory meatusTympanic membraneMastoid process

Causes of Referred Otalgia

NervesC 2,3VVII IXX

Common Causes of Referred Otalgia

• Dental sourcesImpacted tooth (last molar, upper)Dental cariesPeriodontal infectionIll fitting dentures

Pharyngeal causes

• Acute tonsillitis• Peritonsillar abscess• Malignant tumours – Most important

PharynxLarynxOral cavity

Neuralgias

• Clinical examination (ENT & neurological) must be normal

• Trigeminal neuralgia – unilateral facial pain

• Glossopharyngeal neuralgiaunilateral pharyngeal pain

Commonest Causes

• Teeth• TM joint• Tongue (base)• Tonsils• Pharynx• Larynx

DEPARTMENT OF ENT HEAD & NECK SURGERY

COMBINED MILITARY HOSPITAL

RAWALPINDI

Any Questions ?