Ear pain in children: Difference between revisions

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{{CMG}} {{AE}}{{EAM}}
{{CMG}} {{AE}}{{EAM}}


{{SK}} Ear pain in kids<ref name="urlSynonyms for EARACHE - Thesaurus.net2">{{cite web |url=https://www.thesaurus.net/earache#other-synonyms |title=Synonyms for EARACHE - Thesaurus.net |format= |work= |accessdate=}}</ref>= earache, aching, ache, earwig, earreach, erg, ericaceae, erse, erica, eruca, erase, earwax, eris, eureka, eros, Erik Weisz, erose, eurasia.
{{SK}} [[Otalgia|Ear pain]] in kids, [[earache]], [[ear infection]], [[otitis]], [[Otalgia|ear]] [[discomfort]], [[Ear Pain|ear]] [[sore]], [[otalgia]], otodynia.
 
==Overview==


==Historical Perspective==
==Historical Perspective==


*[Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
*In the 1840s , the first [[otoscope]] was invented by [[Anton von Troeltsh]] in [[Germany]] to diagnose [[Otalgia|ear pain]]<ref name="pmid236014802">{{cite journal |vauthors=Conover K |title=Earache |journal=Emerg Med Clin North Am |volume=31 |issue=2 |pages=413–42 |date=May 2013 |pmid=23601480 |doi=10.1016/j.emc.2013.02.001 |url=}}</ref><ref name="pmid11056932">{{cite journal |vauthors=Altemeier WA |title=A pediatrician's view. A brief history of otitis media |journal=Pediatr Ann |volume=29 |issue=10 |pages=599 |date=October 2000 |pmid=11056932 |doi=10.3928/0090-4481-20001001-03 |url=}}</ref>.
*In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
*In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].
   
   
==Classification==
==Classification==


*[Disease name] may be classified according to [classification method] into [number] subtypes/groups:
*[[Otalgia|Ear pain]] in children may be classified according to the anatomic site of [[Ear Pain|er]] [[pain]] :<ref name="pmidPMID: 31751020">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=PMID: 31751020 | doi= | pmc= | url= }}</ref>
 
:*Primary
:*[[Secondary]]
:*Traumatic


:*[group1]
Other variants of [[Otalgia|ear pain in children]] include:<ref name="pmidPMID 24491310">{{cite journal| author=Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA | display-authors=etal| title=Clinical practice guideline: acute otitis externa. | journal=Otolaryngol Head Neck Surg | year= 2014 | volume= 150 | issue= 1 Suppl | pages= S1-S24 | pmid=PMID 24491310 | doi=10.1177/0194599813517083 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24491310  }}</ref>
:*[group2]
:*[group3]


*Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].
*[[Diseases]] of the [[auricle]]
*[[Diseases]] of the [[ear canal]]
*[[Secondary]] [[otalgia]]<ref name="pmidPMID 23601480">{{cite journal| author=Conover K| title=Earache. | journal=Emerg Med Clin North Am | year= 2013 | volume= 31 | issue= 2 | pages= 413-42 | pmid=PMID 23601480 | doi=10.1016/j.emc.2013.02.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23601480  }}</ref>
*[[Diseases]] of the [[Middle ear|middle]] and [[inner ear]]
*Traumatic [[injuries]] to the [[ear]]


==Pathophysiology==
==Pathophysiology==


*The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
*The [[pathogenesis]] of [[Otalgia|ear pain]] in [[children]] is characterized by [[pain]] from the [[ear]] itself which is called primary [[Otalgia|ear pain]] and [[referred pain]] which is called [[Secondary]] [[Otalgia|ear pain]]<ref name="urlEarache - Ear, Nose, and Throat Disorders - MSD Manual Professional Edition">{{cite web |url=https://www.msdmanuals.com/professional/ear,-nose,-and-throat-disorders/approach-to-the-patient-with-ear-problems/earache#:~:text=rarely%2C%20hearing%20loss.-,Pathophysiology,from%20local%20inflammation%2C%20or%20both. |title=Earache - Ear, Nose, and Throat Disorders - MSD Manual Professional Edition |format= |work= |accessdate=}}</ref><ref name="urlChapter 19. Ear | The Big Picture: Gross Anatomy | AccessMedicine | McGraw-Hill Medical">{{cite web |url=https://accessmedicine.mhmedical.com/content.aspx?bookid=381&sectionid=40140027 |title=Chapter 19. Ear &#124; The Big Picture: Gross Anatomy &#124; AccessMedicine &#124; McGraw-Hill Medical |format= |work= |accessdate=}}</ref><ref name="pmid14528091">{{cite journal |vauthors=Scarbrough TJ, Day TA, Williams TE, Hardin JH, Aguero EG, Thomas CR |title=Referred otalgia in head and neck cancer: a unifying schema |journal=Am J Clin Oncol |volume=26 |issue=5 |pages=e157–62 |date=October 2003 |pmid=14528091 |doi=10.1097/01.coc.0000091357.08692.86 |url=}}</ref><ref name="pmid29365233">{{cite journal |vauthors=Earwood JS, Rogers TS, Rathjen NA |title=Ear Pain: Diagnosing Common and Uncommon Causes |journal=Am Fam Physician |volume=97 |issue=1 |pages=20–27 |date=January 2018 |pmid=29365233 |doi= |url=}}</ref> .
*The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
*On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
*On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].


==Causes==
==Causes==
Disease name] may be caused by [cause1], [cause2], or [cause3].
The most common causes of [[Otalgia|ear pain]] in [[children]] are:<ref name="pmidPMID: 18350760">{{cite journal| author=Ely JW, Hansen MR, Clark EC| title=Diagnosis of ear pain. | journal=Am Fam Physician | year= 2008 | volume= 77 | issue= 5 | pages= 621-8 | pmid=PMID: 18350760 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18350760  }}</ref> is primary [[otalgia]] include [[otitis media]] and [[otitis externa]]<ref name="urlSynonyms for EARACHE - Thesaurus.net">{{cite web |url=https://www.thesaurus.net/earache#other-synonyms |title=Synonyms for EARACHE - Thesaurus.net |format= |work= |accessdate=}}</ref> include:
 
1.[[Diseases]] of the [[auricle]] like: [[Cellulitis]] of the [[auricle]], perichondritis,[[Herpes zoster]] oticus, local [[allergic reaction]] (bug bite), [[Contact dermatitis]], [[Sunburn]], [[Frostbite]].
 
2.[[Diseases]] of the [[ear canal]] like: [[Otitis externa]]( [[Bacterial]], [[Fungal]], [[Malignant otitis externa]]), [[Furunculosis]], [[Cerumen impaction]], [[Foreign bodies|foreign bodies]], [[Granuloma]],[[Malignant tumor]], [[Contact dermatitis]], [[Eczema]].
 
3.[[Diseases]] of the [[Middle Ear Disease|middle]] and [[inner ear]] like: [[acute otitis media]], [[eustachian tube dysfunction]], [[Otitis media with effusion]], [[Otitis media]] with [[perforation]], [[Otitis media]] with [[tympanostomy tube]]<nowiki/>s, [[Otitis media|myringitis]], [[cholesteatoma]], [[Malignant tumors|malignant tumor]], [[Complications]] of [[otitis media]]( [[Mastoiditis]], [[Meningitis]], [[Brain abscess]], [[Venous sinus thrombosis]], [[Inner ear|inner]] [[ear infection]], [[Facial nerve palsy]]).
 
Less common [[causes]] of [[ear pain in children]] is [[secondary]] [[otalgia]] which include:<ref name="pmid28784702">{{cite journal| author=Kaur R, Morris M, Pichichero ME| title=Epidemiology of Acute Otitis Media in the Postpneumococcal Conjugate Vaccine Era. | journal=Pediatrics | year= 2017 | volume= 140 | issue= 3 | pages=  | pmid=28784702 | doi=10.1542/peds.2017-0181 | pmc=5574724 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28784702  }}</ref> : [[Temporomandibular joint disorder|temporomandibular joint syndrome]], [[pharyngitis]], [[stomatitis]], auricular [[lymphadenopathy]] or [[lymphadenitis]], [[sinusitis]] ([[maxillary]]),[[Parotitis]], f[[Facial nerve palsy|acial nerve palsy]], [[Psychogenic disease|psychogenic]], [[cervical spine]] [[arthritis]], and [[Dental|denta]]<nowiki/>l [[infections]] but it's more common in adults than [[children]]<ref name="pmid: 29365233">{{cite journal| author=Earwood JS, Rogers TS, Rathjen NA| title=Ear Pain: Diagnosing Common and Uncommon Causes. | journal=Am Fam Physician | year= 2018 | volume= 97 | issue= 1 | pages= 20-27 | pmid=: 29365233 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29365233  }}</ref>. Or traumatic [[injuries]] to the [[ear]] [[abrasions]] or [[lacerations]], [[auricular hematoma]], traumatic [[perforation]] of the [[TM]], [[Disruption (of schema)|disruption]] of the [[ossicles]], hemotympanum ([[Blunted affect|blunt]] or [[barotrauma]]), [[Basilar skull fracture]], associated [[intracranial injury]], [[Inner ear]] injury ([[Blunted affect|blunt]] or [[barotrauma]]).
 
==Differentiating  ear pain in children from other diseases==
 
[[Otalgia|Ear pain]] in [[children]] must be differentiated from:<ref name="pmidPMID: 31931581">{{cite journal| author=Bandúrová V, Plzák J, Bouček J| title=Differential diagnosis of ear pain. | journal=Cas Lek Cesk | year= 2019 | volume= 158 | issue= 6 | pages= 231-234 | pmid=PMID: 31931581 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31931581  }}</ref>
 
'''Auricle''':<ref name="pmid15995516">{{cite journal| author=Ghanem T, Rasamny JK, Park SS| title=Rethinking auricular trauma. | journal=Laryngoscope | year= 2005 | volume= 115 | issue= 7 | pages= 1251-5 | pmid=15995516 | doi=10.1097/01.MLG.0000165377.92622.EF | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15995516  }}</ref>
 
*[[Contusion]] ([[auricular hematoma]]).
 
*[[Infection]]: [[Cellulitis]], [[Perichondritis]], [[Herpes zoster]] oticus ([[Ramsay Hunt syndrome]])<ref name="pmid22445801">{{cite journal| author=Kansu L, Yilmaz I| title=Herpes zoster oticus (Ramsay Hunt syndrome) in children: case report and literature review. | journal=Int J Pediatr Otorhinolaryngol | year= 2012 | volume= 76 | issue= 6 | pages= 772-6 | pmid=22445801 | doi=10.1016/j.ijporl.2012.03.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22445801  }}</ref>.
 
*[[Allergic]] [[angioedema]]
 
*Juvenile spring [[eruption]] ([[polymorphous light eruption]])
 
*Environmental [[injury]]


OR
'''Ear canal:'''


Common causes of [disease] include [cause1], [cause2], and [cause3].
*[[Otitis externa]] <ref name="pmid244913102">{{cite journal| author=Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA | display-authors=etal| title=Clinical practice guideline: acute otitis externa. | journal=Otolaryngol Head Neck Surg | year= 2014 | volume= 150 | issue= 1 Suppl | pages= S1-S24 | pmid=24491310 | doi=10.1177/0194599813517083 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24491310  }}</ref>


OR
*[[Malignant otitis externa]] <ref name="pmid3142986">{{cite journal| author=Rubin J, Yu VL, Stool SE| title=Malignant external otitis in children. | journal=J Pediatr | year= 1988 | volume= 113 | issue= 6 | pages= 965-70 | pmid=3142986 | doi=10.1016/s0022-3476(88)80564-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3142986  }}</ref>


The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
*[[Contact dermatitis]]


OR
*[[Furuncle]]


The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].
*[[Foreign body]]
==Differentiating [disease name] from other Diseases==


For further information about the differential diagnosis, click [[Disease_Name differential diagnosis|here]].
*[[Cerumen impaction]]
 
*[[Tumor]]
 
'''Middle and inner ear:'''
 
*[[Acute otitis media]]<ref name="pmid23439909">{{cite journal| author=Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA | display-authors=etal| title=The diagnosis and management of acute otitis media. | journal=Pediatrics | year= 2013 | volume= 131 | issue= 3 | pages= e964-99 | pmid=23439909 | doi=10.1542/peds.2012-3488 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23439909  }}</ref>
 
*[[Complications]] of [[acute otitis media]] are: spontaneous [[rupture]] of the [[tympanic membrane]] , [[Mastoiditis]], [[Facial palsy]]<ref name="pmid25447953">{{cite journal| author=Mattos JL, Colman KL, Casselbrant ML, Chi DH| title=Intratemporal and intracranial complications of acute otitis media in a pediatric population. | journal=Int J Pediatr Otorhinolaryngol | year= 2014 | volume= 78 | issue= 12 | pages= 2161-4 | pmid=25447953 | doi=10.1016/j.ijporl.2014.09.032 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25447953  }}</ref>, [[Inner ear]] [[infection]], involvement of [[contiguous]] structures<ref name="pmid22224578">{{cite journal| author=Wu JF, Jin Z, Yang JM, Liu YH, Duan ML| title=Extracranial and intracranial complications of otitis media: 22-year clinical experience and analysis. | journal=Acta Otolaryngol | year= 2012 | volume= 132 | issue= 3 | pages= 261-5 | pmid=22224578 | doi=10.3109/00016489.2011.643239 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22224578  }}</ref><ref name="pmid254479532">{{cite journal| author=Mattos JL, Colman KL, Casselbrant ML, Chi DH| title=Intratemporal and intracranial complications of acute otitis media in a pediatric population. | journal=Int J Pediatr Otorhinolaryngol | year= 2014 | volume= 78 | issue= 12 | pages= 2161-4 | pmid=25447953 | doi=10.1016/j.ijporl.2014.09.032 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25447953  }}</ref><ref name="pmid12049560">{{cite journal| author=Zapalac JS, Billings KR, Schwade ND, Roland PS| title=Suppurative complications of acute otitis media in the era of antibiotic resistance. | journal=Arch Otolaryngol Head Neck Surg | year= 2002 | volume= 128 | issue= 6 | pages= 660-3 | pmid=12049560 | doi=10.1001/archotol.128.6.660 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12049560  }}</ref>,
 
*[[Otitis media]] with effusion
 
*[[Eustachian tube dysfunction]]
 
*[[Cholesteatoma]]
 
*[[Blunt trauma|Blunt]] or [[penetrating trauma]]: traumatic [[tympanic membrane perforation]], traumatic disruption of the [[ossicles]] or [[inner ear]]<ref name="pmid14751480">{{cite journal| author=Hurtado TR, Zeger WG| title=Hemotympanums secondary to spontaneous epistaxis in a 7-year-old. | journal=J Emerg Med | year= 2004 | volume= 26 | issue= 1 | pages= 61-3 | pmid=14751480 | doi=10.1016/j.jemermed.2003.05.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14751480  }}</ref>, [[Basilar skull fracture]].
 
'''Secondary otalgia:''' <ref name="pmid23601480">{{cite journal| author=Conover K| title=Earache. | journal=Emerg Med Clin North Am | year= 2013 | volume= 31 | issue= 2 | pages= 413-42 | *pmid=23601480 | doi=10.1016/j.emc.2013.02.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23601480  }}</ref> 
 
*[[Auricular branch|Auricular]] [[lymphadenopathy]] or [[Lymphadenitis-regional non-bacterial|lymphadenitis]].
 
*[[Parotitis]]<ref name="pmid17435413">{{cite journal| author=Battle S, Laudenbach J, Maguire JH| title=Influenza parotitis: a case from the 2004 to 2005 vaccine shortage. | journal=Am J Med Sci | year= 2007 | volume= 333 | issue= 4 | pages= 215-7 | pmid=17435413 | doi=10.1097/MAJ.0b013e31803b92c4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17435413  }}</ref><ref name="pmid25128215">{{cite journal| author=Francis CL, Larsen CG| title=Pediatric sialadenitis. | journal=Otolaryngol Clin North Am | year= 2014 | volume= 47 | issue= 5 | pages= 763-78 | pmid=25128215 | doi=10.1016/j.otc.2014.06.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25128215  }}</ref><ref name="pmid16154645">{{cite journal| author=Stong BC, Sipp JA, Sobol SE| title=Pediatric parotitis: a 5-year review at a tertiary care pediatric institution. | journal=Int J Pediatr Otorhinolaryngol | year= 2006 | volume= 70 | issue= 3 | pages= 541-4 | pmid=16154645 | doi=10.1016/j.ijporl.2005.08.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16154645  }}</ref><ref name="pmid31202035">{{cite journal| author=Tucci FM, Roma R, Bianchi A, De Vincentiis GC, Bianchi PM| title=Juvenile recurrent parotitis: Diagnostic and therapeutic effectiveness of sialography. Retrospective study on 110 children. | journal=Int J Pediatr Otorhinolaryngol | year= 2019 | volume= 124 | issue=  | pages= 179-184 | pmid=31202035 | doi=10.1016/j.ijporl.2019.06.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31202035  }}</ref>,
 
*[[Temporomandibular joint dysfunction (TMJ)|Temporomandibular joint dysfunction]] syndrome,
 
*[[Facial nerve palsy|Facial nerve]] ([[Bell's palsy|Bell's]]) [[palsy]],
 
*[[Oropharyngeal]] [[Infection|infections]],
 
*[[Sinusitis]],
 
*[[Cervical spine injury]]


==Epidemiology and Demographics==
==Epidemiology and Demographics==


*The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
*The [[prevalence]] of [[ear pain]] in [[children]] of:<ref name="pmid265276272">{{cite journal |vauthors=Rosa-Olivares J, Porro A, Rodriguez-Varela M, Riefkohl G, Niroomand-Rad I |title=Otitis Media: To Treat, To Refer, To Do Nothing: A Review for the Practitioner |journal=Pediatr Rev |volume=36 |issue=11 |pages=480–6; quiz 487–8 |date=November 2015 |pmid=26527627 |doi=10.1542/pir.36-11-480 |url=}}</ref><ref name="pmid293652332">{{cite journal |vauthors=Earwood JS, Rogers TS, Rathjen NA |title=Ear Pain: Diagnosing Common and Uncommon Causes |journal=Am Fam Physician |volume=97 |issue=1 |pages=20–27 |date=January 2018 |pmid=29365233 |doi= |url=}}</ref>:
*In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].
*[[Acute otitis media]] is approximately 83% of [[children]] by 3 years of age.
*[[Cerumen impaction]] occurs in 1 out of every 10 [[children]]
   
   
===Age===
===Age===


*Patients of all age groups may develop [disease name].
*[[Otalgia|Ear pain]] in [[children]] especially  primary [[otalgia]] of [[infection]] ([[acute otitis media]]) is more commonly observed among ages 6–24 months .
*[[Ear pain]] of otitis externae is more commonly observed among patients aged 7-12 years old.
*[Disease name] is more commonly observed among patients aged [age range] years old.
*[Disease name] is more commonly observed among [elderly patients/young patients/children].
   
   
===Gender===
===Gender===


*[Disease name] affects men and women equally.
*There is no [[Gender, Institutions and Development Data Base|gender]] predisposition for [[ear pain]] in [[children]].
*[Gender 1] are more commonly affected with [disease name] than [gender 2].
*The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.
   
   
===Race===
===Race===


*There is no racial predilection for [disease name].
*There is no [[racial]] predisposition for [[ear pain]] in [[children]].
*[Disease name] usually affects individuals of the [race 1] race.
*[Race 2] individuals are less likely to develop [disease name].


==Risk Factors==
==Risk Factors==


*Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
*Common [[risk factors]] in the development of [[ear pain]] in [[children]] are :
*[[Allergies]] or [[asthma]], [[ear infections]]<ref name="urlRisk Factors for Middle Ear Infections | Winchester Hospital">{{cite web |url=https://www.winchesterhospital.org/health-library/article?id=19355 |title=Risk Factors for Middle Ear Infections &#124; Winchester Hospital |format= |work= |accessdate=}}</ref>(first [[ear infection]] before six months of age)<ref name="urlwww.lifespan.org">{{cite web |url=https://www.lifespan.org/lifespan-living/ear-pain-children-what-you-should-know |title=www.lifespan.org |format= |work= |accessdate=}}</ref>, and [[family history]] of [[ear infections]].
*[[Coronary artery disease]].
*[[Diabetes]] or [[immunocompromise]].
*Smoker or negative smoker([[tobacco]] smoke exposure).
*[[Unilateral hearing loss]].
*Superior [[Tympanic membrane perforation|tympanic membrane]] retraction pocket.
*[[Otorrhea]] <ref name="urlDiagnosis of Ear Pain - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2008/0301/p621.html#afp20080301p621-b40 |title=Diagnosis of Ear Pain - American Family Physician |format= |work= |accessdate=}}</ref>.


==Natural History, Complications and Prognosis==
==Natural History, Complications and Prognosis==
Common complications of [[ear pain]] ([[infection]]) include:<ref name="urlHealth Content and Patient Education Solutions - Healthwise">{{cite web |url=https://www.healthwise.org/specialpages/legal/abouthw/en.aspx?tab=mdreview&lang=en-us |title=Health Content and Patient Education Solutions - Healthwise |format= |work= |accessdate=}}</ref> <ref name="urlComplications of Ear Infections | CS Mott Childrens Hospital | Michigan Medicine">{{cite web |url=https://www.mottchildren.org/health-library/hw182912 |title=Complications of Ear Infections &#124; CS Mott Children's Hospital &#124; Michigan Medicine |format= |work= |accessdate=}}</ref>
*[[Hearing loss]]
*Problems [[Learning disabilities|learning]] to talk and to understand speech with recurrent [[infections]]
*[[Rupture]] of the [[Eardrum - ruptured or perforated|eardrum]]
*[[Inflammation]] of the [[middle ear]]
*[[Cholesteatoma]]
*Damage to the tiny bones in the [[Middle ear bone complex|middle ear]]
*[[Mastoiditis]](rare)
*[[Meningitis]](rare)


*The majority of patients with [disease name] remain asymptomatic for [duration/years].
[[Prognosis]] is generally good which is resolved symptoms within several days<ref name="urlEarache - Harvard Health">{{cite web |url=https://www.health.harvard.edu/a_to_z/earache-a-to-z |title=Earache - Harvard Health |format= |work= |accessdate=}}</ref><ref name="urlAmerican Academy of Otolaryngology-Head and Neck Surgery |">{{cite web |url=https://www.entnet.org/ |title=American Academy of Otolaryngology-Head and Neck Surgery &#124; |format= |work= |accessdate=}}</ref><ref name="urlEar Infection in Adults: Symptoms, Causes, Diagnosis & More">{{cite web |url=https://www.healthline.com/health/ear-infection-adults |title=Ear Infection in Adults: Symptoms, Causes, Diagnosis & More |format= |work= |accessdate=}}</ref>.
*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].


==Diagnosis==
==Diagnosis==
===Diagnostic Criteria===
===Diagnostic Criteria===


*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
*The [[diagnosis]] of [[acute otitis media]] in [[children]] may made when at least one of the following criteria are met:<ref name="pmid31524361">{{cite journal |vauthors=Gaddey HL, Wright MT, Nelson TN |title=Otitis Media: Rapid Evidence Review |journal=Am Fam Physician |volume=100 |issue=6 |pages=350–356 |date=September 2019 |pmid=31524361 |doi= |url=}}</ref>


:*[criterion 1]
:*[[Pain]] (rubbing, tugging, or holding the [[ear]] may be a [[Sign (medical)|sign]] of [[pain]])
:*[criterion 2]
:*[[Fever]]
:*[criterion 3]
:*[[Irritability]]
:*[criterion 4]
:*[[Otorrhea]]
:*[[Anorexia]]
:*Sometimes [[vomiting]] or [[lethargy]]
   
   
===Symptoms===
===Symptoms===


*[Disease name] is usually asymptomatic.
*[[Ear pain]] in [[children]] is sometimes asymptomatic.
*Symptoms of [disease name] may include the following:
*[[Symptoms]] of [[ear pain]] in [[children]] may include the following:<ref name="urlEar Infection in Children : Symptoms & Risk Factors">{{cite web |url=https://asterhospital.com/blog/ear-infection-in-infants-children/ |title=Ear Infection in Children : Symptoms & Risk Factors |format= |work= |accessdate=}}</ref>
*[[Ear pain]], especially when lying down.
*Tugging or pulling at an [[ear]].
*[[Difficulty sleeping]].
*[[Crying]] more than usual.
*Acting more [[irritable]] than usual.
*[[Difficulty hearing]] or responding to [[sound]]<nowiki/>s.
*[[Loss of balance]]
*[[Fever]] of 100 F (38 C) or higher.
*[[Drainage from the ear|Drainage]] of fluid from the [[ear]].
*[[Headache]]
*[[Loss of appetite]].


:*[symptom 1]
:*[symptom 2]
:*[symptom 3]
:*[symptom 4]
:*[symptom 5]
:*[symptom 6]
===Physical Examination===
===Physical Examination===


*Patients with [disease name] usually appear [general appearance].
*[[Patient|Patients]] that are a [[child]]  with [[ear pain]] usually appear either stable with [[discomfort]] and holding their [[ear]] and [[crying]], younger [[infants]] or toddlers may be fussy and difficult to console. Or with [[abnormal]] [[vital signs]] like [[ear pain]], [[epidural hematoma]], and  abnormal [[mental status]] due to [[brain infection]] or [[traumatic injury]]<ref name="pmidPMID 244913102">{{cite journal| author=Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA | display-authors=etal| title=Clinical practice guideline: acute otitis externa. | journal=Otolaryngol Head Neck Surg | year= 2014 | volume= 150 | issue= 1 Suppl | pages= S1-S24 | pmid=PMID 24491310 | doi=10.1177/0194599813517083 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24491310  }}</ref>.
*Physical examination may be remarkable for:
*[[Physical examination]] may be remarkable for:<ref name="pmid27610432">{{cite journal| author=Harrison E, Cronin M| title=Otalgia. | journal=Aust Fam Physician | year= 2016 | volume= 45 | issue= 7 | pages= 493-7 | pmid=27610432 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27610432  }}</ref>:


:*[finding 1]
:*Abnormal [[vital signs]] due to serious [[infection]], like [[meningitis]], [[sepsis]], or serious [[traumatic injury]], like [[epidural hematoma]].
:*[finding 2]
:*Holding their [[ear]] and [[crying]] in sever [[otitis media]] or externa.
:*[finding 3]
:*Moderate to severe [[hearing loss]].
:*[finding 4]
:*[[Traumatic injury]] like [[lacerations]], [[ecchymoses]], fluctuant hematomas, or [[swelling]].
:*[finding 5]
:*[[Periorbital bruising|Periorbital]] [[ecchymoses]] [[signs]] of [[basilar skull fracture]].
:*[finding 6]
:*[[Battle's sign|Battle's sign]] ([[ecchymosis]] overlying the [[mastoid bone]])
:*Diffuse [[redness]] and [[swelling]] of the [[external ear]] due to  indicate [[infection]] or local [[Allergic Reaction|allergic reaction]]
:*Protrusion of the [[ear]] from the side of the [[head]] due to either  [[allergic]] or [[infectious]] [[inflammation]] of the [[pinna]] or [[mastoiditis]].
:*[[Pre-auricular lymph nodes|Pre]]- or [[Postauricular inflammation and swelling|postauricular]] [[lymphadenopathy]] presence of any fluctuance and overlying [[redness]] or [[swelling]].


===Laboratory Findings===
===Laboratory Findings===
[[Imaging studies]]; and [[consultation]] with an [[otolaryngologist]]<ref name="pmidPMID: 183507602">{{cite journal| author=Ely JW, Hansen MR, Clark EC| title=Diagnosis of ear pain. | journal=Am Fam Physician | year= 2008 | volume= 77 | issue= 5 | pages= 621-8 | pmid=PMID: 18350760 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18350760  }}</ref>


*There are no specific laboratory findings associated with [disease name].
*There are no specific [[Laboratory findings template|laboratory findings]] associated with [[ear pain]] in [[children]].
 
*An elevated concentration of [[CBC]], [[ESR]], and [[CRP]] is diagnostic of serious or deep-seated [[infections]], such as [[mastoiditis]], [[malignant otitis externa]], or [[bacterial meningitis]] .
*A  [positive/negative] [test name] is diagnostic of [disease name].
*Other [[Laboratory findings template|laboratory findings]] consistent with the [[diagnosis]] of [[ear pain]] in [[children]] include [[bacterial]] or [[fungal]] [[Culture-bound syndrome|culture]] of [[Otorrhea|ear drainage]], [[blood culture]], [[lumbar puncture]]<ref name="pmid3784900">{{cite journal |vauthors=Chun CH, Johnson JD, Hofstetter M, Raff MJ |title=Brain abscess. A study of 45 consecutive cases |journal=Medicine (Baltimore) |volume=65 |issue=6 |pages=415–31 |date=November 1986 |pmid=3784900 |doi= |url=}}</ref><ref name="pmid3363298">{{cite journal |vauthors=Schliamser SE, Bäckman K, Norrby SR |title=Intracranial abscesses in adults: an analysis of 54 consecutive cases |journal=Scand J Infect Dis |volume=20 |issue=1 |pages=1–9 |date=1988 |pmid=3363298 |doi=10.3109/00365548809117210 |url=}}</ref><ref name="pmid6877531">{{cite journal |vauthors=Nielsen H |title=Cerebral abscess in children |journal=Neuropediatrics |volume=14 |issue=2 |pages=76–80 |date=May 1983 |pmid=6877531 |doi=10.1055/s-2008-1059557 |url=}}</ref><ref name="pmid7786422">{{cite journal |vauthors=Patir R, Sood S, Bhatia R |title=Post-traumatic brain abscess: experience of 36 patients |journal=Br J Neurosurg |volume=9 |issue=1 |pages=29–35 |date=1995 |pmid=7786422 |doi= |url=}}</ref><ref name="pmid12893401">{{cite journal |vauthors=Tattevin P, Bruneel F, Clair B, Lellouche F, de Broucker T, Chevret S, Bédos JP, Wolff M, Régnier B |title=Bacterial brain abscesses: a retrospective study of 94 patients admitted to an intensive care unit (1980 to 1999) |journal=Am J Med |volume=115 |issue=2 |pages=143–6 |date=August 2003 |pmid=12893401 |doi=10.1016/s0002-9343(03)00292-4 |url=}}</ref>,and [[Audiometry]].
*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].


===Electrocardiogram===
===Electrocardiogram===
There are no ECG findings associated with [disease name].
An [[ECG]] may be helpful in the [[diagnosis]] of [[carcinoma]] of the [[middle ear]] in [[children]]<ref name="pmid32369024">{{cite journal |vauthors=Brunner A, Kovacevic A |title=[Atrial dissociation in a boxer with a carcinoma of the middle ear] |language=German |journal=Schweiz Arch Tierheilkd |volume=162 |issue=5 |pages=319–323 |date=May 2020 |pmid=32369024 |doi=10.17236/sat00260 |url=}}</ref>. Findings on an [[ECG]] suggestive of [[carcinoma]] of the [[middle ear]] include [[atrial dissociation]].
 
OR
 
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


===X-ray===
===X-ray===
There are no x-ray findings associated with [disease name].
An [[X-rays|x-ray]] may be helpful in the [[diagnosis]] of the [[inner ear]]. Findings on an [[x-ray]] suggestive of microstructure defects or [[tumors]] include [[otoconia]] masses, most of the [[morphology]] studies of the [[inner ear]]<ref name="pmid30636063">{{cite journal |vauthors=Yin HX, Zhang P, Wang Z, Liu YF, Liu Y, Xiao TQ, Yang ZH, Xian JF, Zhao PF, Li J, Lv H, Ding HY, Liu XH, Zhu JM, Wang ZC |title=Investigation of inner ear anatomy in mouse using X-ray phase contrast tomography |journal=Microsc Res Tech |volume=82 |issue=7 |pages=953–960 |date=July 2019 |pmid=30636063 |doi=10.1002/jemt.23121 |url=}}</ref><ref name="urlEarache & Ear Pain Causes, Treatment, Remedies & Symptoms">{{cite web |url=https://www.emedicinehealth.com/earache/article_em.htm |title=Earache & Ear Pain Causes, Treatment, Remedies & Symptoms |format= |work= |accessdate=}}</ref>.
 
OR
 
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].
[[Echocardiography]] may be helpful in the [[diagnosis]] of [[carcinoma]] of the middle ear in [[children]]. Findings on an [[echocardiography]] suggestive of [[carcinoma]] of the [[middle ear]] include [[atrial]] dissociation<ref name="pmid323690242">{{cite journal |vauthors=Brunner A, Kovacevic A |title=[Atrial dissociation in a boxer with a carcinoma of the middle ear] |language=German |journal=Schweiz Arch Tierheilkd |volume=162 |issue=5 |pages=319–323 |date=May 2020 |pmid=32369024 |doi=10.17236/sat00260 |url=}}</ref><ref name="pmid297981142">{{cite journal |vauthors=Hao XP, Yang BT, Lei L, Wei XM, Li YX |title=[The characteristics of CT scan and MRI images of middle ear adenomas] |language=Chinese |journal=Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi |volume=31 |issue=21 |pages=1625–1629 |date=November 2017 |pmid=29798114 |doi=10.13201/j.issn.1001-1781.2017.21.001 |url=}}</ref>.
 
OR
 
Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===CT scan===
===CT scan===
There are no CT scan findings associated with [disease name].
There are no [[CT-scans|CT]] scan findings associated with [[ear pain]] in [[children]]. However, a [[CT scan]]<ref name="pmid6631519">{{cite journal |vauthors=Britt RH, Enzmann DR |title=Clinical stages of human brain abscesses on serial CT scans after contrast infusion. Computerized tomographic, neuropathological, and clinical correlations |journal=J Neurosurg |volume=59 |issue=6 |pages=972–89 |date=December 1983 |pmid=6631519 |doi=10.3171/jns.1983.59.6.0972 |url=}}</ref> may be helpful in the [[diagnosis]] of [[complications]] of [[otitis media]] in [[ear pain]] in [[children]], which include altered [[mental status]] in conjunction with [[Cardiovascular|cardiovascula]]<nowiki/>r instability, [[fever]], [[Focal neurologic signs|focal neurologic]] findings, [[meningismus]], and severe [[headache]], [[complications]], such as [[venous sinus thrombosis]], [[meningitis]], or [[brain abscess]] should be suspected.
 
OR
 
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===MRI===
===MRI===
There are no MRI findings associated with [disease name].
Ear [[MRI]]( [[Magnetic resonance imaging]]) and referral for nasolaryngoscopymay be helpful in the [[diagnosis]] of [[ear pain]] in [[children]] in the setting of [[otalgia]] with normal ear examination findings and [[symptoms]] of or [[risk factors]] for a [[tumor]]<ref name="urlDiagnosis of Ear Pain - American Family Physician3">{{cite web |url=https://www.aafp.org/afp/2008/0301/p621.html#afp20080301p621-b40 |title=Diagnosis of Ear Pain - American Family Physician |format= |work= |accessdate=}}</ref> . Findings on [[MRI]]<ref name="pmid29798114">{{cite journal |vauthors=Hao XP, Yang BT, Lei L, Wei XM, Li YX |title=[The characteristics of CT scan and MRI images of middle ear adenomas] |language=Chinese |journal=Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi |volume=31 |issue=21 |pages=1625–1629 |date=November 2017 |pmid=29798114 |doi=10.13201/j.issn.1001-1781.2017.21.001 |url=}}</ref> [[diagnostic]] of [[ear tumor]] include equal [[T1]] and [[T2 phage|T2]] signals with intensifying in tympanum, and long [[T1]] or equal [[T1]] and long [[T2 phage|T2]] signal in mastoid showed obstructive [[inflammation]].
 
OR
 
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


OR
<br />
 
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===Other Imaging Findings===
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].
There are no other [[imaging]] findings associated with [[ear pain]] in [[children]].
 
OR
 
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


===Other Diagnostic Studies===
===Other Diagnostic Studies===


*[Disease name] may also be diagnosed using [diagnostic study name].
*[[Ear pain]] in [[children]] is usually diagnosed using an [[otoscope]]  <ref name="pmidPMID: 18245001">{{cite journal| author=Siddiq MA, Samra MJ| title=Otalgia. | journal=BMJ | year= 2008 | volume= 336 | issue= 7638 | pages= 276-7 | pmid=PMID: 18245001 | doi=10.1136/bmj.39364.643275.47 | pmc=2223060 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18245001  }}</ref>, or [[tympanometry]] can be helpful if there is suspicion of [[Middle ear infection|middle ear]] [[disease]]:<ref name="urlDiagnosis of Ear Pain - American Family Physician2">{{cite web |url=https://www.aafp.org/afp/2008/0301/p621.html#afp20080301p621-b40 |title=Diagnosis of Ear Pain - American Family Physician |format= |work= |accessdate=}}</ref>
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
*Findings<ref name="pmid24491310">{{cite journal |vauthors=Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA, Huang WW, Haskell HW, Robertson PJ |title=Clinical practice guideline: acute otitis externa |journal=Otolaryngol Head Neck Surg |volume=150 |issue=1 Suppl |pages=S1–S24 |date=February 2014 |pmid=24491310 |doi=10.1177/0194599813517083 |url=}}</ref>on [[Otoscope|otoscop]]<nowiki/>i<nowiki/>c examination include [[redness]], flaking, [[swelling]], or thick [[discharge]] of [[ear canal]], presence of masses, [[foreign bodies]], bullae, or [[Eczematous Scaling|eczematous]] changes, and  the [[TM]] appears thickened or cloudy, or if air [[Bubble bath allergy|bubble]]<nowiki/>s a<nowiki/>re evident behind the [[TM]], a [[middle ear]] effusion should be suspected, [[Tenseness|tense]], [[pus]]-filled bullae may be seen in [[AOM]](Auditory canal and [[middle ear]]), [[redness]] or bullae of the [[TM]] without evident fluid in the [[middle ear]] suggests isolated [[Myringitis bullosa|myringitis]], perforations of the TM, inserted [[tympanostomy tube]] can see location and patency should be assessed, in cases of [[Trauma|traum]]<nowiki/>a, <nowiki/>hemotympanum may be noted. Hemotympanum is characterized by a red or [[Purple bacteria|purple]] effusion, which may occupy the entire [[middle ear]] space or may appear as an air-fluid level.


==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===


*There is no treatment for [disease name]; the mainstay of therapy is supportive care.
*The mainstay of [[therapy]] for [[ear pain]] in [[children]] are over-the-counter drugs like [[Tylenol]]([[acetaminophen]]) or [[ibuprofen]] ([[Advil]], [[Motrin]]) and [[Anesthetics|anesthetic]] drops, warm compresses for some kinds of [[bacterial]] [[ear infections]]<ref name="urlEar and Mastoid Disorders in Infants and Children | Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e | AccessMedicine | McGraw-Hill Medical">{{cite web |url=https://accessmedicine.mhmedical.com/content.aspx?bookid=1658&sectionid=109432406 |title=Ear and Mastoid Disorders in Infants and Children &#124; Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e &#124; AccessMedicine &#124; McGraw-Hill Medical |format= |work= |accessdate=}}</ref>, DIY remedies<ref name="url3 Home Remedies for an Ear Infection – Health Essentials from Cleveland Clinic2">{{cite web |url=https://health.clevelandclinic.org/3-home-remedies-for-an-ear-infection/ |title=3 Home Remedies for an Ear Infection – Health Essentials from Cleveland Clinic |format= |work= |accessdate=}}</ref> , [[antibiotics]] for [[ear infections]] even its not effective [[treatment]]<ref name="urlEar infection (middle ear) - Diagnosis and treatment - Mayo Clinic">{{cite web |url=https://www.mayoclinic.org/diseases-conditions/ear-infections/diagnosis-treatment/drc-20351622 |title=Ear infection (middle ear) - Diagnosis and treatment - Mayo Clinic |format= |work= |accessdate=}}</ref><ref name="pmid24134083">{{cite journal |vauthors=Harmes KM, Blackwood RA, Burrows HL, Cooke JM, Harrison RV, Passamani PP |title=Otitis media: diagnosis and treatment |journal=Am Fam Physician |volume=88 |issue=7 |pages=435–40 |date=October 2013 |pmid=24134083 |doi= |url=}}</ref>:
   
*Acute bacterial [[otitis externa]] (AOE), [[necrotizing]] [[external otitis]]<ref name="pmid20736106">{{cite journal |vauthors=Neilan RE, Roland PS |title=Otalgia |journal=Med Clin North Am |volume=94 |issue=5 |pages=961–71 |date=September 2010 |pmid=20736106 |doi=10.1016/j.mcna.2010.05.004 |url=}}</ref>.
*The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
*[[Acute otitis media]] ([[AOM]])<ref name="pmid207361062">{{cite journal |vauthors=Neilan RE, Roland PS |title=Otalgia |journal=Med Clin North Am |volume=94 |issue=5 |pages=961–71 |date=September 2010 |pmid=20736106 |doi=10.1016/j.mcna.2010.05.004 |url=}}</ref>.
*[Medical therapy 1] acts by [mechanism of action 1].
*[[Acute]] [[folliculitis]]<ref name="pmid207361063">{{cite journal |vauthors=Neilan RE, Roland PS |title=Otalgia |journal=Med Clin North Am |volume=94 |issue=5 |pages=961–71 |date=September 2010 |pmid=20736106 |doi=10.1016/j.mcna.2010.05.004 |url=}}</ref>.
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
*[[Auricular branch|Auricular]] [[cellulitis]]<ref name="urlSore Throat, Earache, and Upper Respiratory Symptoms | Harrisons Manual of Medicine, 19e | AccessMedicine | McGraw-Hill Medical">{{cite web |url=https://accessmedicine.mhmedical.com/content.aspx?bookid=1820&sectionid=127554985 |title=Sore Throat, Earache, and Upper Respiratory Symptoms &#124; Harrison's Manual of Medicine, 19e &#124; AccessMedicine &#124; McGraw-Hill Medical |format= |work= |accessdate=}}</ref>.
*[[Tympanic membrane perforation|Tympanic membrane]] rupture<ref name="urlSore Throat, Earache, and Upper Respiratory Symptoms | Harrisons Manual of Medicine, 19e | AccessMedicine | McGraw-Hill Medical2">{{cite web |url=https://accessmedicine.mhmedical.com/content.aspx?bookid=1820&sectionid=127554985 |title=Sore Throat, Earache, and Upper Respiratory Symptoms &#124; Harrison's Manual of Medicine, 19e &#124; AccessMedicine &#124; McGraw-Hill Medical |format= |work= |accessdate=}}</ref>
*Perichondritis<ref name="pmid207361065">{{cite journal |vauthors=Neilan RE, Roland PS |title=Otalgia |journal=Med Clin North Am |volume=94 |issue=5 |pages=961–71 |date=September 2010 |pmid=20736106 |doi=10.1016/j.mcna.2010.05.004 |url=}}</ref>
*[[Sinusitis]] <ref name="pmid207361064">{{cite journal |vauthors=Neilan RE, Roland PS |title=Otalgia |journal=Med Clin North Am |volume=94 |issue=5 |pages=961–71 |date=September 2010 |pmid=20736106 |doi=10.1016/j.mcna.2010.05.004 |url=}}</ref>
*[[Necrotizing]] [[external otitis]]
*[[Acute]] [[mastoiditis]]
*[[Chondritis]]
   
   
===Surgery===
==='''Surgery'''===


*Surgery is the mainstay of therapy for [disease name].
*[[Surgery operation|Surgery]] is the mainstay of [[therapy]] for [[cholesteatoma]] (Abnormal [[squamous epithelium]]) [[Polypoidy|polypoid]] [[disease]], and [[infected]] [[bone]] that must be removed in order to create a dry, safe ear that is free of [[infection]]<ref name="pmidPMID: 8694138">{{cite journal| author=Jackson CG, Schall DG, Glasscock ME, Macias JD, Widick MH, Touma BJ| title=A surgical solution for the difficult chronic ear. | journal=Am J Otol | year= 1996 | volume= 17 | issue= 1 | pages= 7-14 | pmid=PMID: 8694138 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8694138  }}</ref>.
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*[[Surgical procedure]]s like:
*[Surgical procedure] can only be performed for patients with [disease stage] [disease name].
*[[Debridement]] can only be performed for patients with chronic perichondritis and [[chondritis]].
*[[Keratosis]] obturans is treated with removal of impacted desquamated [[keratin]] debris in the [[ear canal]].
*[[Foreign body]] in the [[ear canal]] can cause [[pain]] and be treated with careful removal.
*Infected [[sebaceous cyst]] is treated with [[incision]] and [[Drainage from the ear|drainage]] of the [[cysts]], [[oral antibiotics]] and [[otorhinolaryngology]] assessment.
   
   
===Prevention===
===Prevention===


*There are no primary preventive measures available for [disease name].
*Effective measures for the [[primary prevention]] of [[ear pain]] in [[children]] include not [[smoking]], and avoiding [[secondhand smoke]]<ref name="urlHealth Effects of Secondhand Smoke | CDC">{{cite web |url=https://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects/index.htm |title=Health Effects of Secondhand Smoke &#124; CDC |format= |work= |accessdate=}}</ref>,Keep all [[Foreign body|foreign]] objects out of your [[ears]]  always take time to carefully dry your [[ear]]<nowiki/>s after [[swimming]], showering, or bathing, and You can also wear a bathing cap, earplugs, or use custom-fitted swim molds when [[swimming]]<ref name="urlwww.cdc.gov">{{cite web |url=https://www.cdc.gov/healthywater/pdf/swimming/resources/pseudomonas-factsheet_swimmers_ear.pdf |title=www.cdc.gov |format= |work= |accessdate=}}</ref>. Hold a [[hair]] drier on a low [[heat]] setting at least 12 inches from the [[ear]]<ref name="urlEarache & Ear Pain Causes, Treatment, Remedies & Symptoms2">{{cite web |url=https://www.emedicinehealth.com/earache/article_em.htm |title=Earache & Ear Pain Causes, Treatment, Remedies & Symptoms |format= |work= |accessdate=}}</ref>
*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
 
*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
 
[[Category:Primary care]]
[[Category:Pediatrics]]
[[Category:Pediatrics]]
[[Category:Up-To-Date]]

Latest revision as of 21:17, 24 February 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Eman Alademi, M.D.[2]

Synonyms and keywords: Ear pain in kids, earache, ear infection, otitis, ear discomfort, ear sore, otalgia, otodynia.

Historical Perspective

Classification

  • Ear pain in children may be classified according to the anatomic site of er pain :[3]

Other variants of ear pain in children include:[4]

Pathophysiology

Causes

The most common causes of ear pain in children are:[10] is primary otalgia include otitis media and otitis externa[11] include:

1.Diseases of the auricle like: Cellulitis of the auricle, perichondritis,Herpes zoster oticus, local allergic reaction (bug bite), Contact dermatitis, Sunburn, Frostbite.

2.Diseases of the ear canal like: Otitis externa( Bacterial, Fungal, Malignant otitis externa), Furunculosis, Cerumen impaction, foreign bodies, Granuloma,Malignant tumor, Contact dermatitis, Eczema.

3.Diseases of the middle and inner ear like: acute otitis media, eustachian tube dysfunction, Otitis media with effusion, Otitis media with perforation, Otitis media with tympanostomy tubes, myringitis, cholesteatoma, malignant tumor, Complications of otitis media( Mastoiditis, Meningitis, Brain abscess, Venous sinus thrombosis, inner ear infection, Facial nerve palsy).

Less common causes of ear pain in children is secondary otalgia which include:[12] : temporomandibular joint syndrome, pharyngitis, stomatitis, auricular lymphadenopathy or lymphadenitis, sinusitis (maxillary),Parotitis, facial nerve palsy, psychogenic, cervical spine arthritis, and dental infections but it's more common in adults than children[13]. Or traumatic injuries to the ear abrasions or lacerations, auricular hematoma, traumatic perforation of the TM, disruption of the ossicles, hemotympanum (blunt or barotrauma), Basilar skull fracture, associated intracranial injury, Inner ear injury (blunt or barotrauma).

Differentiating ear pain in children from other diseases

Ear pain in children must be differentiated from:[14]

Auricle:[15]

Ear canal:

Middle and inner ear:

Secondary otalgia: [25]

Epidemiology and Demographics

Age

Gender

Race

Risk Factors

Natural History, Complications and Prognosis

Common complications of ear pain (infection) include:[35] [36]

Prognosis is generally good which is resolved symptoms within several days[37][38][39].

Diagnosis

Diagnostic Criteria

Symptoms

Physical Examination

Laboratory Findings

Imaging studies; and consultation with an otolaryngologist[44]

Electrocardiogram

An ECG may be helpful in the diagnosis of carcinoma of the middle ear in children[50]. Findings on an ECG suggestive of carcinoma of the middle ear include atrial dissociation.

X-ray

An x-ray may be helpful in the diagnosis of the inner ear. Findings on an x-ray suggestive of microstructure defects or tumors include otoconia masses, most of the morphology studies of the inner ear[51][52].

Echocardiography or Ultrasound

Echocardiography may be helpful in the diagnosis of carcinoma of the middle ear in children. Findings on an echocardiography suggestive of carcinoma of the middle ear include atrial dissociation[53][54].

CT scan

There are no CT scan findings associated with ear pain in children. However, a CT scan[55] may be helpful in the diagnosis of complications of otitis media in ear pain in children, which include altered mental status in conjunction with cardiovascular instability, fever, focal neurologic findings, meningismus, and severe headache, complications, such as venous sinus thrombosis, meningitis, or brain abscess should be suspected.

MRI

Ear MRI( Magnetic resonance imaging) and referral for nasolaryngoscopymay be helpful in the diagnosis of ear pain in children in the setting of otalgia with normal ear examination findings and symptoms of or risk factors for a tumor[56] . Findings on MRI[57] diagnostic of ear tumor include equal T1 and T2 signals with intensifying in tympanum, and long T1 or equal T1 and long T2 signal in mastoid showed obstructive inflammation.


Other Imaging Findings

There are no other imaging findings associated with ear pain in children.

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

References

  1. ↑ Conover K (May 2013). "Earache". Emerg Med Clin North Am. 31 (2): 413–42. doi:10.1016/j.emc.2013.02.001. PMID 23601480.
  2. ↑ Altemeier WA (October 2000). "A pediatrician's view. A brief history of otitis media". Pediatr Ann. 29 (10): 599. doi:10.3928/0090-4481-20001001-03. PMID 11056932.
  3. ↑ "StatPearls". 2020. PMID 31751020 PMID: 31751020 Check |pmid= value (help).
  4. ↑ Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA; et al. (2014). "Clinical practice guideline: acute otitis externa". Otolaryngol Head Neck Surg. 150 (1 Suppl): S1–S24. doi:10.1177/0194599813517083. PMID 24491310 PMID 24491310 Check |pmid= value (help).
  5. ↑ Conover K (2013). "Earache". Emerg Med Clin North Am. 31 (2): 413–42. doi:10.1016/j.emc.2013.02.001. PMID 23601480 PMID 23601480 Check |pmid= value (help).
  6. ↑ "Earache - Ear, Nose, and Throat Disorders - MSD Manual Professional Edition".
  7. ↑ "Chapter 19. Ear | The Big Picture: Gross Anatomy | AccessMedicine | McGraw-Hill Medical".
  8. ↑ Scarbrough TJ, Day TA, Williams TE, Hardin JH, Aguero EG, Thomas CR (October 2003). "Referred otalgia in head and neck cancer: a unifying schema". Am J Clin Oncol. 26 (5): e157–62. doi:10.1097/01.coc.0000091357.08692.86. PMID 14528091.
  9. ↑ Earwood JS, Rogers TS, Rathjen NA (January 2018). "Ear Pain: Diagnosing Common and Uncommon Causes". Am Fam Physician. 97 (1): 20–27. PMID 29365233.
  10. ↑ Ely JW, Hansen MR, Clark EC (2008). "Diagnosis of ear pain". Am Fam Physician. 77 (5): 621–8. PMID 18350760 PMID: 18350760 Check |pmid= value (help).
  11. ↑ "Synonyms for EARACHE - Thesaurus.net".
  12. ↑ Kaur R, Morris M, Pichichero ME (2017). "Epidemiology of Acute Otitis Media in the Postpneumococcal Conjugate Vaccine Era". Pediatrics. 140 (3). doi:10.1542/peds.2017-0181. PMC 5574724. PMID 28784702.
  13. ↑ Earwood JS, Rogers TS, Rathjen NA (2018). "Ear Pain: Diagnosing Common and Uncommon Causes". Am Fam Physician. 97 (1): 20–27. PMID 29365233 : 29365233 Check |pmid= value (help).
  14. ↑ Bandúrová V, Plzák J, Bouček J (2019). "Differential diagnosis of ear pain". Cas Lek Cesk. 158 (6): 231–234. PMID 31931581 PMID: 31931581 Check |pmid= value (help).
  15. ↑ Ghanem T, Rasamny JK, Park SS (2005). "Rethinking auricular trauma". Laryngoscope. 115 (7): 1251–5. doi:10.1097/01.MLG.0000165377.92622.EF. PMID 15995516.
  16. ↑ Kansu L, Yilmaz I (2012). "Herpes zoster oticus (Ramsay Hunt syndrome) in children: case report and literature review". Int J Pediatr Otorhinolaryngol. 76 (6): 772–6. doi:10.1016/j.ijporl.2012.03.003. PMID 22445801.
  17. ↑ Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA; et al. (2014). "Clinical practice guideline: acute otitis externa". Otolaryngol Head Neck Surg. 150 (1 Suppl): S1–S24. doi:10.1177/0194599813517083. PMID 24491310.
  18. ↑ Rubin J, Yu VL, Stool SE (1988). "Malignant external otitis in children". J Pediatr. 113 (6): 965–70. doi:10.1016/s0022-3476(88)80564-x. PMID 3142986.
  19. ↑ Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA; et al. (2013). "The diagnosis and management of acute otitis media". Pediatrics. 131 (3): e964–99. doi:10.1542/peds.2012-3488. PMID 23439909.
  20. ↑ Mattos JL, Colman KL, Casselbrant ML, Chi DH (2014). "Intratemporal and intracranial complications of acute otitis media in a pediatric population". Int J Pediatr Otorhinolaryngol. 78 (12): 2161–4. doi:10.1016/j.ijporl.2014.09.032. PMID 25447953.
  21. ↑ Wu JF, Jin Z, Yang JM, Liu YH, Duan ML (2012). "Extracranial and intracranial complications of otitis media: 22-year clinical experience and analysis". Acta Otolaryngol. 132 (3): 261–5. doi:10.3109/00016489.2011.643239. PMID 22224578.
  22. ↑ Mattos JL, Colman KL, Casselbrant ML, Chi DH (2014). "Intratemporal and intracranial complications of acute otitis media in a pediatric population". Int J Pediatr Otorhinolaryngol. 78 (12): 2161–4. doi:10.1016/j.ijporl.2014.09.032. PMID 25447953.
  23. ↑ Zapalac JS, Billings KR, Schwade ND, Roland PS (2002). "Suppurative complications of acute otitis media in the era of antibiotic resistance". Arch Otolaryngol Head Neck Surg. 128 (6): 660–3. doi:10.1001/archotol.128.6.660. PMID 12049560.
  24. ↑ Hurtado TR, Zeger WG (2004). "Hemotympanums secondary to spontaneous epistaxis in a 7-year-old". J Emerg Med. 26 (1): 61–3. doi:10.1016/j.jemermed.2003.05.001. PMID 14751480.
  25. ↑ Conover K (2013). "Earache". Emerg Med Clin North Am. 31 (2): 413–42. doi:10.1016/j.emc.2013.02.001. Unknown parameter |*pmid= ignored (help)
  26. ↑ Battle S, Laudenbach J, Maguire JH (2007). "Influenza parotitis: a case from the 2004 to 2005 vaccine shortage". Am J Med Sci. 333 (4): 215–7. doi:10.1097/MAJ.0b013e31803b92c4. PMID 17435413.
  27. ↑ Francis CL, Larsen CG (2014). "Pediatric sialadenitis". Otolaryngol Clin North Am. 47 (5): 763–78. doi:10.1016/j.otc.2014.06.009. PMID 25128215.
  28. ↑ Stong BC, Sipp JA, Sobol SE (2006). "Pediatric parotitis: a 5-year review at a tertiary care pediatric institution". Int J Pediatr Otorhinolaryngol. 70 (3): 541–4. doi:10.1016/j.ijporl.2005.08.001. PMID 16154645.
  29. ↑ Tucci FM, Roma R, Bianchi A, De Vincentiis GC, Bianchi PM (2019). "Juvenile recurrent parotitis: Diagnostic and therapeutic effectiveness of sialography. Retrospective study on 110 children". Int J Pediatr Otorhinolaryngol. 124: 179–184. doi:10.1016/j.ijporl.2019.06.007. PMID 31202035.
  30. ↑ Rosa-Olivares J, Porro A, Rodriguez-Varela M, Riefkohl G, Niroomand-Rad I (November 2015). "Otitis Media: To Treat, To Refer, To Do Nothing: A Review for the Practitioner". Pediatr Rev. 36 (11): 480–6, quiz 487–8. doi:10.1542/pir.36-11-480. PMID 26527627.
  31. ↑ Earwood JS, Rogers TS, Rathjen NA (January 2018). "Ear Pain: Diagnosing Common and Uncommon Causes". Am Fam Physician. 97 (1): 20–27. PMID 29365233.
  32. ↑ "Risk Factors for Middle Ear Infections | Winchester Hospital".
  33. ↑ "www.lifespan.org".
  34. ↑ "Diagnosis of Ear Pain - American Family Physician".
  35. ↑ "Health Content and Patient Education Solutions - Healthwise".
  36. ↑ "Complications of Ear Infections | CS Mott Children's Hospital | Michigan Medicine".
  37. ↑ "Earache - Harvard Health".
  38. ↑ "American Academy of Otolaryngology-Head and Neck Surgery |".
  39. ↑ "Ear Infection in Adults: Symptoms, Causes, Diagnosis & More".
  40. ↑ Gaddey HL, Wright MT, Nelson TN (September 2019). "Otitis Media: Rapid Evidence Review". Am Fam Physician. 100 (6): 350–356. PMID 31524361.
  41. ↑ "Ear Infection in Children : Symptoms & Risk Factors".
  42. ↑ Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA; et al. (2014). "Clinical practice guideline: acute otitis externa". Otolaryngol Head Neck Surg. 150 (1 Suppl): S1–S24. doi:10.1177/0194599813517083. PMID 24491310 PMID 24491310 Check |pmid= value (help).
  43. ↑ Harrison E, Cronin M (2016). "Otalgia". Aust Fam Physician. 45 (7): 493–7. PMID 27610432.
  44. ↑ Ely JW, Hansen MR, Clark EC (2008). "Diagnosis of ear pain". Am Fam Physician. 77 (5): 621–8. PMID 18350760 PMID: 18350760 Check |pmid= value (help).
  45. ↑ Chun CH, Johnson JD, Hofstetter M, Raff MJ (November 1986). "Brain abscess. A study of 45 consecutive cases". Medicine (Baltimore). 65 (6): 415–31. PMID 3784900.
  46. ↑ Schliamser SE, Bäckman K, Norrby SR (1988). "Intracranial abscesses in adults: an analysis of 54 consecutive cases". Scand J Infect Dis. 20 (1): 1–9. doi:10.3109/00365548809117210. PMID 3363298.
  47. ↑ Nielsen H (May 1983). "Cerebral abscess in children". Neuropediatrics. 14 (2): 76–80. doi:10.1055/s-2008-1059557. PMID 6877531.
  48. ↑ Patir R, Sood S, Bhatia R (1995). "Post-traumatic brain abscess: experience of 36 patients". Br J Neurosurg. 9 (1): 29–35. PMID 7786422.
  49. ↑ Tattevin P, Bruneel F, Clair B, Lellouche F, de Broucker T, Chevret S, Bédos JP, Wolff M, Régnier B (August 2003). "Bacterial brain abscesses: a retrospective study of 94 patients admitted to an intensive care unit (1980 to 1999)". Am J Med. 115 (2): 143–6. doi:10.1016/s0002-9343(03)00292-4. PMID 12893401.
  50. ↑ Brunner A, Kovacevic A (May 2020). "[Atrial dissociation in a boxer with a carcinoma of the middle ear]". Schweiz Arch Tierheilkd (in German). 162 (5): 319–323. doi:10.17236/sat00260. PMID 32369024 Check |pmid= value (help).
  51. ↑ Yin HX, Zhang P, Wang Z, Liu YF, Liu Y, Xiao TQ, Yang ZH, Xian JF, Zhao PF, Li J, Lv H, Ding HY, Liu XH, Zhu JM, Wang ZC (July 2019). "Investigation of inner ear anatomy in mouse using X-ray phase contrast tomography". Microsc Res Tech. 82 (7): 953–960. doi:10.1002/jemt.23121. PMID 30636063.
  52. ↑ "Earache & Ear Pain Causes, Treatment, Remedies & Symptoms".
  53. ↑ Brunner A, Kovacevic A (May 2020). "[Atrial dissociation in a boxer with a carcinoma of the middle ear]". Schweiz Arch Tierheilkd (in German). 162 (5): 319–323. doi:10.17236/sat00260. PMID 32369024 Check |pmid= value (help).
  54. ↑ Hao XP, Yang BT, Lei L, Wei XM, Li YX (November 2017). "[The characteristics of CT scan and MRI images of middle ear adenomas]". Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi (in Chinese). 31 (21): 1625–1629. doi:10.13201/j.issn.1001-1781.2017.21.001. PMID 29798114.
  55. ↑ Britt RH, Enzmann DR (December 1983). "Clinical stages of human brain abscesses on serial CT scans after contrast infusion. Computerized tomographic, neuropathological, and clinical correlations". J Neurosurg. 59 (6): 972–89. doi:10.3171/jns.1983.59.6.0972. PMID 6631519.
  56. ↑ "Diagnosis of Ear Pain - American Family Physician".
  57. ↑ Hao XP, Yang BT, Lei L, Wei XM, Li YX (November 2017). "[The characteristics of CT scan and MRI images of middle ear adenomas]". Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi (in Chinese). 31 (21): 1625–1629. doi:10.13201/j.issn.1001-1781.2017.21.001. PMID 29798114.
  58. ↑ Siddiq MA, Samra MJ (2008). "Otalgia". BMJ. 336 (7638): 276–7. doi:10.1136/bmj.39364.643275.47. PMC 2223060. PMID 18245001 PMID: 18245001 Check |pmid= value (help).
  59. ↑ "Diagnosis of Ear Pain - American Family Physician".
  60. ↑ Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA, Huang WW, Haskell HW, Robertson PJ (February 2014). "Clinical practice guideline: acute otitis externa". Otolaryngol Head Neck Surg. 150 (1 Suppl): S1–S24. doi:10.1177/0194599813517083. PMID 24491310.
  61. ↑ "Ear and Mastoid Disorders in Infants and Children | Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 8e | AccessMedicine | McGraw-Hill Medical".
  62. ↑ "3 Home Remedies for an Ear Infection – Health Essentials from Cleveland Clinic".
  63. ↑ "Ear infection (middle ear) - Diagnosis and treatment - Mayo Clinic".
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  65. ↑ Neilan RE, Roland PS (September 2010). "Otalgia". Med Clin North Am. 94 (5): 961–71. doi:10.1016/j.mcna.2010.05.004. PMID 20736106.
  66. ↑ Neilan RE, Roland PS (September 2010). "Otalgia". Med Clin North Am. 94 (5): 961–71. doi:10.1016/j.mcna.2010.05.004. PMID 20736106.
  67. ↑ Neilan RE, Roland PS (September 2010). "Otalgia". Med Clin North Am. 94 (5): 961–71. doi:10.1016/j.mcna.2010.05.004. PMID 20736106.
  68. ↑ "Sore Throat, Earache, and Upper Respiratory Symptoms | Harrison's Manual of Medicine, 19e | AccessMedicine | McGraw-Hill Medical".
  69. ↑ "Sore Throat, Earache, and Upper Respiratory Symptoms | Harrison's Manual of Medicine, 19e | AccessMedicine | McGraw-Hill Medical".
  70. ↑ Neilan RE, Roland PS (September 2010). "Otalgia". Med Clin North Am. 94 (5): 961–71. doi:10.1016/j.mcna.2010.05.004. PMID 20736106.
  71. ↑ Neilan RE, Roland PS (September 2010). "Otalgia". Med Clin North Am. 94 (5): 961–71. doi:10.1016/j.mcna.2010.05.004. PMID 20736106.
  72. ↑ Jackson CG, Schall DG, Glasscock ME, Macias JD, Widick MH, Touma BJ (1996). "A surgical solution for the difficult chronic ear". Am J Otol. 17 (1): 7–14. PMID 8694138 PMID: 8694138 Check |pmid= value (help).
  73. ↑ "Health Effects of Secondhand Smoke | CDC".
  74. ↑ "www.cdc.gov" (PDF).
  75. ↑ "Earache & Ear Pain Causes, Treatment, Remedies & Symptoms".
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