Download - EARACHE & REFERRED OTALGIA
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 ?