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Symptom A To Logy of Ear
Symptom A To Logy of Ear
Symptom A To Logy of Ear
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
Symptoms associated with ear disease
Duration
Acute
Chronic
Acute on chronic
Severity
What way it disturbs you & your works.
Amount
Scanty
Profuse
Otorrhoea
Laterality
Unilateral
Bilateral
Periodicity
Constant
Intermittent
How much gap between two episode
Is it seasonal
Associated URTI
Otorrhoea
Character
Watery
CSF otorrhoea
Viral myringitis
Mucoid
Mucopurulent
Purulent
Blood stained
Smell
Odorless
Foul smelling
Important causes
Otitis externa (swimmer's ear)
–Most common source of otorrhea
–Usually associated with water contamination or cotton
swab abuse
–Pain with movement of pinna
–Usually secondary to Pseudomonas or Staphylococcus
infection
Malignant otitis externa
–Also known as necrotizing external otitis and skull base
osteomyelitis
–Suspect in patients with diabetes or
immunosuppression who present with persistent
otorrhea, ear pain, and granulation tissue in the ear
canal –Usually secondary to Pseudomonas
Important causes
Foreign body
–Frequently a retained cotton swab
–Often occurs in toddlers
Otitis media (acute or chronic) with perforated
tympanic membrane
Cholesteatoma
–A skin-lined cyst of the middle ear or mastoid that
occurs secondary to chronic otitis media
–In most cases there is fullness, bulging, or a white
mass of the tympanic membrane (may easily be
confused with ear wax)
Important causes
Mastoiditis
–Tenderness or bogginess over mastoid
Cerebrospinal fluid otorrhea
–Clear, colorless discharge through a tympanic
membrane perforation or tympanostomy tube
–Patients usually have a history of trauma or
surgery, but CSF otorrhea may occasionally be
spontaneous
Diagnostic workup
A thorough cleaning of the ear canal under direct
visualization (with magnification is ideal) with a
curette or suction is necessary to determine the
source of discharge
*The presence or absence of tympanic
membrane pathology must be determined
*The absence of tympanic membrane pathology
usually 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
Diagnostic workup
E a r p a i n i s a n e x t r e m el y c o m m o n
presenting complaint in both
p r i m a r y c a r e a n d o t o l a r y n g o l o gy
practice.
Important causes
Otitis media
–Most cases are of viral origin
–Red tympanic membrane with decreased mobility
Otitis externa
–Pain upon movement of tragus
Malignant (necrotizing) otitis externa
–Usually due to Pseudomonas –Mostly seen in
diabetics
Referred otalgia
–TMJ: May result in ear pain, jaw pain, neck
pain, and/or headache
–Dental infection, trauma, or orthodontic
intervention (e.g., tightening of braces)
–Pharyngitis or tonsillitis
–Post-tonsillectomy/adenoidectomy
Referred otalgia
Onset
Sudden
Insidious
Duration
Unilateral/Bilateral
Constant/intermittant
Static/progressive
Severity
What way it disturbs you & your works.
Otalgia
Character
Dull aching, stabbing, cutting or pricking
Aggravating factors
Relieving factors
Referred pain
Workup and Diagnosis
Autophony
Hears own voice when speaking
OME
Abnormal Eustachian tube
Hypercusis
Undue sensitivity of loud sound sound
Stapedial nerve paralysis
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
Swelling in pre/post auricular area
Blunt trauma
Cauliflower ear
Auricular Hematoma
Foreign Body Ear
qEmergency when
associated with
vertigo, profound
hearing loss and/ or
facial paralysis
qDo not irrigate
organic material or
with a perforation
qOtologic examinaion
reveals FB
q
Cerumen