symptom a to logy of ear

8/14/2019 Symptom a to Logy of Ear

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SYMPTOMATOLOGY OF EAR


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Symptomatology of ear

Ear discharge (otorrhoea)Ear ache (otalgia)

Hearing loss

Tinnitus

Itching ear /Foreign body/wax ear

Giddiness/Vertigo

Swelling in pre/post auricular area

Bleeding from ear

Deformity of pinna

Autophony/hyperacusis


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Symptoms associated with ear disease

Inability to close eye

Deviation of angle of mouth

Nausea , vomiting

Light headnessHeadache

Fever

Retro-orbital painDiplopia


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Otorrhea, or ear discharge

ear discharge usually results from an inflammatoryprocess in the ear canal, middle ear, or mastoid.

A thorough cleaning of the ear canal (with suction ifpossible) is essential to determine the source of theotorrhea

CSF otorrhea must always be considered in patientswith recent face or head trauma or


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Otorrhoea

Onset Sudden Insidious

Duration

Acute ChronicAcute on chronic

Severity

What way it disturbs you & your works.Amount

Scanty Profuse


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Otorrhoea

Laterality Unilateral

Bilateral

Periodicity Constant Intermittent

How much gap between two episode Is it seasonal

Associated URTI


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Otorrhoea

CharacterWatery

CSF otorrhoea

Viral myringitis

Mucoid Mucopurulent

Purulent

Blood stained

Smell Odorless

Foul smelling


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Important causes

Otitis externa (swimmer's ear)Most common source of otorrheaUsually associated with water contamination or cottonswab abusePain with movement of pinnaUsually secondary toPseudomonas orStaphylococcusinfection

Malignant otitis externaAlso known as necrotizing external otitis and skull base

osteomyelitisSuspect in patients with diabetes orimmunosuppression who present with persistentotorrhea, ear pain, and granulation tissue in the earcanal Usually secondary toPseudomonas


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Important causes

Foreign bodyFrequently a retained cotton swabOften occurs in toddlers

Otitis media (acute or chronic) with perforated

tympanic membraneCholesteatoma

A skin-lined cyst of the middle ear or mastoid thatoccurs secondary to chronic otitis media

In most cases there is fullness, bulging, or a whitemass of the tympanic membrane (may easily beconfused with ear wax)


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Important causes

MastoiditisTenderness or bogginess over mastoid

Cerebrospinal fluid otorrheaClear, colorless discharge through a tympanicmembrane perforation or tympanostomy tubePatients usually have a history of trauma orsurgery, but CSF otorrhea may occasionally bespontaneous


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Diagnostic workup

A thorough cleaning of the ear canal under directvisualization (with magnification is ideal) with acurette or suction is necessary to determine thesource of discharge

*The presence or absence of tympanicmembrane pathology must be determined*The absence of tympanic membrane pathologyusually signifies that the source of otorrhea is

limited to the external ear canal*Unless the ear canal is cleaned with suction,many pathologies will not be identified*Ear lavage should be avoided with otorrhea


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Diagnostic workup

Ear cultures from the canal may be helpful inpersistent cases; however, contamination by normalear canal flora usually decreases their value

If CSF otorrhea is suspected, an assay for 2transferrin will identify CSF from other fluids

CT of the temporal bones is helpful in evaluation ofpatients with suspected cholesteatoma, mastoiditis,

and CSF otorrheaGallium and technetium scans may be helpful in

patients with malignant external otitis
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TINNITUS

qFalse Perception of sound in absence of acoustic stimulus in the earv Ringing, Hissing, Humming, Roaring, Buzzing, tickling

Duration

Laterality

Unilateral- Usually local Bilateral usually central cause

Periodicity Constant

Intermittent

Severity Tolerable

Unable to sleep


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&innitus different ear:isorders

External ear:-Wax-Foreign body-Otitis externa

Middle ear:-Otosclerosis-Otitis Media-Glomus juglaretumour

Cochlea:-Noise induced-Presbyacusis

-Menieres disease-Ototoxicity

Retro-cochlear:

-AcousticNeuroma


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Ear pain is an extremely commonpresenting complaint in both

primary care and otolaryngologypractice.

Earache
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Important causes

Otitis mediaMost cases are of viral originRed tympanic membrane with decreased mobility

Eustachian tube dysfunctionCommon in young children


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Important causes

Otitis externaPain upon movement of tragus

Malignant (necrotizing) otitis externaUsually due toPseudomonas Mostly seen indiabetics


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Referred otalgia

TMJ: May result in ear pain, jaw pain, neckpain, and/or headache

Dental infection, trauma, or orthodonticintervention (e.g., tightening of braces)Pharyngitis or tonsillitisPost-tonsillectomy/adenoidectomy


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Referred otalgia

Retropharyngeal abscess and other ENT deep-spaceinfectionsCervical adenitisSinusitis/rhinitis

LaryngitisTrigeminal neuralgiaEsophagitisCervical spine arthritis

Parotiditis/sialoadenitis (including mumps)Angina/acute coronary syndrome
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Important causes

Trauma: Laceration, abrasion, barotrauma (e.g., deep seadiving, airplane)

CellulitisTympanostomy tube obstruction

Myringitis bullosaFurunculosis (localized abscess)Varicella or herpes simplex/zoster infection in the ear canalMastoiditis

Ear protrudes anteriorlyTumorEczema/psoriasisMumps


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Otalgia

Character Dull aching, stabbing, cutting or pricking

Aggravating factors

Relieving factorsReferred pain


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Workup and Diagnosis

History and physical examination, including otoscopicexam with pneumatic otoscopy and complete headand neck examinationPain upon traction of pinna suggests otitis externa

(hyperemic external canal)Bulging, red, immobile tympanic membrane isconsistent with acute otitis media (with or withoutotorrhea secondary to perforation)


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qRetracted, immobile tympanic membrane may beseen in serous otitis media

qMass lesion behind tympanic membrane suggests

cholesteotoma or tumorq

Tonsillar asymmetry or uvular deviation suggestsperitonsillar abscess or mass

q

Workup and Diagnosis


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qTympanometry may reveal otitis media witheffusion, eustachian tube dysfunction, or

tympanostomy tube obstructionqAudiometry to evaluate for hearing loss

qConsider culture of otorrhea if perforation (notcanal) or complicated (e.g., recurrent infection,

spread of infection such as meningitis ormastoiditis)

q


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Lateral neck X-ray will diagnose retropharyngealmass or abscess

Head CT is indicated if intracranial lesion or basilarskull fracture is suspected

Consider CBC and ESR if suspect malignantnecrotizing otitis media

Check glucose in recurrent severe otitis externa


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Autophony/ Hypercusis

Autophony Hears own voice when speaking

OME

Abnormal Eustachian tube

Hypercusis

Undue sensitivity of loud sound sound Stapedial nerve paralysis


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Bleeding from ear

Onset

Duration

Unilateral/Bilateral

Constant/intermittant

Static/progressive

History suggestive of aetiology

Post traumatic (sever head injury, barotraumas,physical assult)

Haemangioma, glomus jugular tumour


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Blunt traumaCauliflower ear

Swelling in pre/post auricular area


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Auricular Hematoma


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Foreign Body Ear

qEmergency whenassociated withvertigo, profoundhearing loss and/ or

facial paralysisqDo not irrigate

organic material orwith a perforation

qOtologic examinaionreveals FB

q


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Cerumen

Ear wax is a mixture of secretions fromceruminous and pilosebaceous glands andsquames of epithelium, dust, and otherdebris.


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qPatients present complaining of loss of hearing,tinnitus, vertigo, otalgia, aural fullness, cough(reflexive through stimulation of the auricularbranch)

qPredisposing factors: hairy ear canals, narrow earcanals, osteomata, in-the-ear hearing aids.

qTreatmentqCeruminolytics

qBicarbonate solution

qOlive oil

qGlycerine

Cerumen


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SYRINGING

Indications for Ear Syringing Totally occlusive cerumen with,Pain Reduced hearing

Tinnitus

Otitis externa if ear suctioning apparatus not available

Contraindications to Ear Syringing Non-occlusive cerumen

Previous ear surgery (including ventilation tubes)

Only hearing ear

Known tympanic membrane perforationAge under 16 years (debatable)


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q

qIf wax appears hard, use a ceruminolytic for a fewdays prior to syringing

q

Warm tap water or saline to about 37oCqClean, smoothly functioning manual syringe

Syringing

symptom a to logy of ear

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