Makindo Medical Notes"One small step for man, one large step for Makindo" |
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π Otalgia (ear pain) can be due to primary causes (within the ear itself) or secondary/referred causes (from jaw, throat, teeth, or sinuses). Most cases are benign, but recognising red flags such as fever, severe swelling, cranial nerve palsy, or systemic illness is crucial for safe practice. π Always differentiate local ear disease from referred otalgia, and remember that adults with persistent unilateral ear pain and a normal otoscopy need exclusion of head & neck malignancy.
Condition | Symptoms | Diagnosis | Management |
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π Otitis Externa (βSwimmerβs earβ) | Ear pain worse on pinna traction, itching, discharge, fullness | Otoscopy: inflamed, narrowed canal Β± debris | Topical Abx/steroid drops, aural toilet, keep dry |
π₯ Acute Otitis Media | Severe pain (esp. children), fever, irritability, β hearing | Bulging, red TM; tympanometry if recurrent | Oral antibiotics (amoxicillin), analgesia, watchful waiting in mild cases |
β»οΈ Chronic Otitis Media | Persistent discharge, hearing loss, foul smell (cholesteatoma) | Otoscopy: perforation/granulation; CT if cholesteatoma | Topical Abx, surgery (tympanoplasty/mastoidectomy) |
π Eustachian Tube Dysfunction | Ear pressure, muffled hearing, difficulty equalising (flights/diving) | Retracted TM, tympanometry | Nasal steroids, decongestants, Valsalva; grommets if chronic |
π₯ Mastoiditis (Emergency) | Severe pain, fever, swelling behind ear, auricle pushed forward | Clinical + CT mastoid | IV antibiotics, mastoidectomy if abscess or unresponsive |
π¦· TMJ Dysfunction | Ear pain worse on chewing, jaw clicking, tenderness | Clinical exam; MRI if persistent | NSAIDs, jaw physiotherapy, bite splints, dental referral |
π§Έ Foreign Body (common in children) | Sudden pain, hearing loss, bleeding/discharge | Seen on otoscopy | Careful removal; avoid irrigation if organic; topical Abx if inflamed |
βοΈ Barotrauma | Pain during altitude changes, ear fullness, perforation possible | Otoscopy Β± tympanometry | Decongestants, nasal steroids, Valsalva; observe for perforation healing |
π¦ Herpes Zoster Oticus (Ramsay Hunt) | Severe otalgia, vesicles around ear, VII palsy, hearing loss, vertigo | Clinical diagnosis; MRI if atypical | Acyclovir + steroids, analgesia, physiotherapy for facial palsy |