Nirali DesaiBPA 1: Common Symptoms

Ear Pain

Otalgia, pain in the ear, is a consequence of primary otologic disease, which can result from internal, middle, or external ear disease or referred otalgia, a pathologic condition that arises from processes other than the ear (Neilan and Roland, 2010). Otalgia in children is typically from primary disease, however referred otalgia is commonly found in adults (Neiland and Rolan, 2010).

Typical sources of primary otalgia are external otitis, otitis media, mastoiditis, and auricular infections (Li, 2013). Draining ear, tympanic membrane perforation, and associated pathology can confirm a diagnosis, however absence of tympanic membrane perforation can make diagnosis difficult (Li, 2013). Since many systems can cause referred otalgia, the relationship to ear pain must first be identified. Complete understanding of the cranial nerves and innervation of these nerves are crucial to determining the primary cause of referred otalgia (Li, 2013). Common symptoms associated with primary otolgia include: otorrhea, hearing loss, aural fullness, or vertigo (Neiland and Roland, 2010). Common symptoms associated with referred otalgia include: history of fever, sore throat, reflux symptoms, hoarseness, sinusitis symptoms, or recent dental work (Visvanathan and Kelly).

A dangerous otologic disease is necrotizing otitis externa, a potentially fatal infection that affect the underlying bone (Neiland and Roland, 2010). Persistent symptoms, include, deep-seated otalgia for more than 1 week, purulent otorrhea with granulation tissue in the ear canal, and/or the development of facial paralysis. Another rare, but serious complication of otalgia can be malignant upper aerodigestive tract tumors. Extensive testing is required for diagnosis.

A history and physical is required for disease diagnosis. A history must include otologic symptomology, swallowing disorders, sinus issues, cervicofacial pain syndromes (e.g., neuralgias), trauma, and a cardiopulmonary history (Li, 2013). The physical should contain extensive otologic inspection of the pinna, post auricular area, external auditory canal, and tympanic membrane; neuro-otologic inspection, and head and neck exams (inspection of nasal cavity, oral cavity, and larynx) (Neiland and Rolan, 2010). Complete blood counts, rhinoscopy, nasopharyngoscopy, and laryngoscopy can be utilized as well. Thyroid disease, adenopathy, and musculoskeletal disorders can be identified via neck palpitation.

Typically, a rich history and physical should be sufficient for diagnosis of otalgia cause, but other diagnostic tests can be completed for confirmation. These include, tympanometry (a middle ear test that creates variations in air pressure), audiometry (a test examining ability to hear sounds) , and magnetic resonance imaging (MRI) or computed tomography (CT) (Roland and Neilan, 2010).

References

Li, J.C. (2013). Otalgia. http://emedicine.medscape.com/article/845173-overview

Neilan, R.E. & Roland, P.S. (2010). Otalgia. Medical Clinics of North America. 94 (5). 961-971.

Visvanathan, V. & Kelly, G. (2010). 12 minute consultation: an evidence-based management of referred otalgia. Clinical Otolaryngology. 35 (5). 409-414.