Earache discharge and ear ache
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Transcript of Earache discharge and ear ache
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Ear ache & Ear discharge
Dr T Balasubramanian
Anatomy
External ear
Middle ear
Internal ear
External ear
Pinna
External auditory canal
Lateral surface of ear drum
PINNA - ANATOMY
PINNA INNERVATION
Pinna Innervation
External auditory canal
Outer 1/3 cartilagenous
Inner 2/3 bony
About an inch long
Postero-superior wall 25 mm
Antero-inferior wall 31 mm
External canal - Innervation
Innervation of middle ear
Sensory supply to middle ear is via glossopharyngeal component of tympanic plexus
Jacobson's branch of glossopharyngeal nerve is the precise supply
Medial portion of ear drum is supplied via chorda tymopani
Inner ear innervation
Inner ear is supplied by vestibulocochlear nerve
This nerve doesnt have pain fibers, significant pathologies of inner ear can develop without painful symptoms
Vestibulocochlear nerves are sensitive to stretch. In Meniere's disease considerable enlargment of membranous labyrinth can cause stretching of these nerves leading on to a sense of fullness in the ear
Otalgia
Is defined as pain localised to the ear
It can either be primary / referred
Primary otalgia is caused by pathology localized to the ear
Referred otalgia is caused by disorders not related to the ear but to its nerve supply
Primary otalgia
External ear causes
Middle ear causes
Inner ear causes
External ear causes of otalgia
Also known as otitis externa
This is a very painful condition
Patient usually lose sleep
Tragal sign positive
Otitis externa classification
Acute diffuse otitis externa (commonly bacterial)
Acute localised otitis externa (Furuncle)
Chronic otitis externa
Eczematous otitis externa
Fungal otitis externa
Malignant otitis externa
Otitis externa Predisposing factors
Absence of cerumen
Removal of cerumen by ear buds
Frequent exposure to water
Anti infective role of cerumen
Protects external canal skin from moisture
It has antibacterial properties
Lowers the pH of external canal making the environment difficult for pathogens to colonize
Role of water in otitis externa
Macrerates skin lining of external canal
Increases the pH of external canal making the environment favorable for bacterial colonization
Furuncle
Tragal sign positive
Affects cartilagenous portion of external canal because of hair follicles
Staph aureus is the common infecting organism
Acute diffuse otitis externa
Also known as swimmer's ear
Skin of external canal is involved in a diffuse manner
Water exposure is the common cause
External canal is itchy
External canal diameter is reduced due to oedema
Conductive deafness (rare)
Chronic otitis externa
Unrelenting pruritus
Mild pain
External canal skin appears dry
Fungal infections commonly cause this problem
Dermatological condition like eczema
Managment
Treatment of infection
Removal of epithelial debris
IG paint dipped wick to reduce oedema
Anti-inflammatory drugs
Otomycosis
Malignant otitis externa
Misnormer
Common in elderly diabetics
Pseudomonas is the causative organism
External canal granulation
Facial paralysis
Erosion of temporal bone
Nocturnal otalgia
Malignant otitis externa (contd)
History of trivial trauma (ear bud use) +
Granulation begins at the bony cartilagenous junction
Discharge from external canal scanty
No fever / constitutional symptoms
Malignant otitis externa (Images)
Bullous myringitis
Also known as bullous otitis externa
Acute infection of ear drum and external auditory canal
There is intra epithelial fluid collection
Bullae may be present over the lateral surface of ear drum
Bullae may also be present in the external auditory canal
Otalgia with serous / bloody ear discharge common
Management of Bullous myringitis
Decompression of bullae if otalgia is intense
Topical / oral antibiotics
Steroids
Analgesics
Middle ear causes of otalgia
Acute otitis media (AOM)
Eustachean tube dysfunction
Otitis barotrauma
AOM
Ear drum could be seen bulging
Accumulation of fluid in the middle ear cavity
Preceded by URI
Common in children
Pain subsides when drum perforates
Ramsay Hunt Syndrome
Herpes zoster oticus
Otalgia +
Facial palsy (LMN)
Rash over ipsilateral pinna / external canal
Otalgia is due to irritation of 7th nerve due to Herpes virus infection
Ramsay Hunt syndrome (Contd)
Relapsing polychondritis
Involves cartilage of pinna and external auditory canal
Intense otalgia is seen
End stage is fibrosis
Sparing of lobule differentiates it from cellulitis
Neoplasms
Primary neoplasms of pinna / external canal
Neoplasms involving skull base
Malignancy involving ceruminous glands
Miscellaneous causes
Trauma
Hematoma
Seroma
Frost bite
Burns / Thermal injuries
Referred otalgia
TM joint disorders
Eagle syndrome
Gerd
Neuralgias
Neoplasms of oropharynx/oral cavity
Cervical arthritis
Ear discharge
Wax (Normal)
Pus
Mucous
Blood
CSF
Saliva
Purulent discharge
Acute suppurative otitis media
Chronic suppurative otitis media
Rupturing furuncle of external auditory canal
Sinister ear discharge
Scanty
Purulent
Discharge associated with excessive otalgia
Discharge associated with giddiness
Discharge associated with head ache
Discharge associated with tinnitus
Otoscopy
Complications of discharging ear
Deafness
Extracranial Intra temporal complication
Extra cranial complication
Intra cranial complication
Facial nerve paralysis
Lateral sinus thrombosis
Thank you
Management
Aural toilet
Culture
Topical antibiotics CSOM
Systemic antibiotics ASOM / AOM
Resistant cases / unsafe - surgery
Autor: drtbalugeetha 18.04.12