Otalgia

External Ear Disorders

1. O t algia BY, VEDANTHA VINOD ASSISTANT LECTURER CCON-MYSORE

2. INTRODUCTION MEANING TYPES ETIOLOGY RISK FACTORS PATHOPHYSIOLOGY CLINICAL MANIFESTATIONS MANAGEMENT PRECAUTIONS CONTENTS TO BE DISCUSSED:-

3. INTRODUCTION Pain in the inner or outer ear that may interfere with ability to hear ,often caused by excess fluid and infection.

4. Is defined as pain in the ear or ear ache. MEANING

5. T ypes Primary Otalgia Referred Otalgia

6. PRIMARY OTALGIA pain that originates within the ear is primary otalgia. Typical sources of primary otalgia are external otitis , otitis media , mastoiditis, and auricular infections. The ear can be anatomically divided into the  external ear , the  external auditory canal , the middle ear, and the  inner ear . These three are indistinguishable in terms of the pain experienced.

7. REFERRED OTALGIA Many different nerves provide sensation to the various parts of the ear . Includes cranial nerves V ( trigeminal ), VII ( facial ), IX ( glossopharyngeal ), and X ( vagus ), and the  great auricular nerve  (cervical nerves C2-C3).  These nerves also supply other parts of the body, from the mouth to the chest and abdomen. Irritation of these nerves in another part of the body has the potential to produce pain in the ear. This is called referred pain. Irritation of the trigeminal nerve (cranial nerve V) is the most common cause of referred ear pain.

8. REFERRED OTALGIA FROM NECK AND HEAD SOURCES

9. Etiology of Primary Otalgia Laceration & bite Hematoma Otitis externa Perichondritis Infected pre-auricular sinus Frostbite, sunburn Neoplasm Pinna External auditory canal Impacted wax Foreign body Keratosis obturans Otitis externa Herpes zoster oticus Exostoses Neoplasm

10. Middle Ear Bullous myringitis Acute otitis media Hemotympanum Otitic barotrauma Neop l asm Ma s t oid Mastoiditis Mastoid abscess Granulomas Secretory otitis media Neoplasm Traumatic perforation Inner ear Acoustic trauma Meniere’s disease Vestibular schwannoma

11. Cholesteatoma It is a cyst in the middle ear or mastoid system that is lined with squamous epithelium and filled with keratin debris. It occurs due to COM

12. ETIOLOGY OF REFERRED OTALGIA

13. Teeth: infection, impacted 3rd molar, malocclusion Oral cavity: infection, ulcer, malignancy, Ludwig’s angina, sialadenitis, salivary calculus Temporo-mandibular joint: arthritis, dysfunction Nose & PNS: impacted DNS, sinusitis, neoplasm Nasopharynx: infection, post- adenoidectomy, adenoiditis, tumor Trigeminal neuralgia A. VIA TRIGEMINAL NERVE

14. B. VIA GLOSSOPHARYNGEAL NERVE Tonsil: tonsillitis, peritonsillar abscess, post- tonsillectomy, neoplasm Oropharynx: infection, ulcer, retropharyngeal + parapharyngeal abscess, trauma, neoplasm Eagle’s syndrome (stylalgia) Glossopharyngeal neuralgia

15. C. VIA FACIAL NERVE: Herpes zoster oticus, vestibular schwannoma Lary n x D. VIA VAGUS NERVE: + hypopharynx : neoplasm, infection, tuberculosis, trauma, foreign body E. VIA SECOND & THIRD CERVICAL NERVES: Herpes zoster, cervical spondylosis & arthritis

16. Risk factors Insertion of unclean/sharp articles into the ear Instillation of contaminated solutions Swimming in polluted water Recent Upper Respiratory Tract Infection Eustachian tube dysfunction Allergies

17. Pathophysiology Trauma or infection Inflammation Release of inflammatory mediators & chemotaxis of leukocytes Tissue edema, pain, heat and redness

18. Clinical manifestations Ear pain can present in one or both ears. It may or may not be accompanied by other symptoms such as Fever, Sensation of the world spinning , ear itchiness, or a sense of fullness in the ear. The pain may or may not worsen with chewing.  The pain may also be continuous or intermittent. Ear pain due to an infection is the most common in children and can occur in babies.  Adults may need further evaluation if they have hearing loss, dizziness or ringing in the ear. Additional red flags include diabetes, a weakened immune system, swelling seen on the outer ear, or swelling along the jaw.

19. Management Promote healing : Ear irrigation Antibiotics Alleviate pain : Analgesics Restore normal function and remove foreign bodies:

20. SURGICAL management Myringoplasty : Closure of simple perforation of tympanic membrane. Tympanoplasty: Surgical correction of the perforated Tympanic membrane. Ossiculoplasty: Ossicular reconstruction Myringotomy: An incision to the tympanic membrane through which fluid is removed. Mastoidectomy:

21. Precautions after ear surgery Client must lye with operated ear up for several hours after surgery. If necessary, the client should blow the nose gently one side at a time. The client should sneeze or cough with the mouth open for 1 week after surgery. Participation in water sports or activities is prohibited.

22. Avoid physical activity for 1 week & exercise or sports for 3 weeks after surgery. Avoid heavy lifting. Change the cotton ball in the ear daily. Keep the ear dry for 4-6 weeks. Do not shampoo for 1 week. Avoid airplane flights for the first week after surgery. For sensation of ear pressure , hold your nose, close your mouth and swallow to equalize pressure. Wear noise defenders in loud environments. Inform in case of bleeding from ear.

23. INTRODUCTION MEANING TYPES ETIOLOGY RISK FACTORS PATHOPHYSIOLOGY CLINICAL MANIFESTATIONS MANAGEMENT PRECAUTIONS DISCUSSED CONTENTS:-