Ear pain in children: Difference between revisions

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


{{SK}} Ear pain in kids, earache, ear ache, ear infection, otitis, ear discomfort, ear sore, otalgia, otodynia.
{{SK}} [[Otalgia|Ear pain]] in kids, [[earache]], [[ear infection]], [[otitis]], [[Otalgia|ear]] [[discomfort]], [[Ear Pain|ear]] [[sore]], [[otalgia]], otodynia.


=='''Historical Perspective'''==
==Historical Perspective==


*[[Ear pan]] in children 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==


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


*Other variants of ear pain in children include<ref name="urlUpToDate2">{{cite web |url=https://www.uptodate.com/contents/evaluation-of-earache-in-children?search=cause%20of%20ear%20pain&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3 |title=UpToDate |format= |work= |accessdate=}}</ref> Diseases of the auricle , Diseases of the ear canal], Secondary otalgia, Diseases of the middle and inner ear, and Traumatic injuries to the ear.
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>
 
*[[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 ear pain in children  is characterized by <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>Pain from the ear itself  which called Primary ear pain<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> and Referred pain which called Secondary ear pain<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 [[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> .


==Causes==
==Causes==
The most common cause of ear pain in children<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:  
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.
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.
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 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).  
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 include <ref name="urlUpToDate">{{cite web |url=https://www.uptodate.com/contents/evaluation-of-earache-in-children?search=cause%20of%20ear%20pain&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3 |title=UpToDate |format= |work= |accessdate=}}</ref>[temporomandibular joint syndrome],[ pharyngitis], stomatitis, Auricular lymphadenopathy or lymphadenitis, Sinusitis (maxillary),Parotitis,Facial nerve palsy, Psychogenic, cervical spine arthritis, and dental infections but its 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 the ossicles, Hemotympanum (blunt or barotrauma), Basilar skull fracture, Associated intracranial injury, Inner ear injury (blunt or barotrauma).
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==
==Differentiating  ear pain in children from other diseases==


Ear pain in children must be differentiated from:<ref name="urlUpToDate3">{{cite web |url=https://www.uptodate.com/contents/evaluation-of-earache-in-children?search=Pathophysiology%20ear%20pain&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2 |title=UpToDate |format= |work= |accessdate=}}</ref><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>  
[[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>  
'''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).
*[[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>.
*[[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
*[[Allergic]] [[angioedema]]


*Juvenile spring eruption (polymorphous light eruption)
*Juvenile spring [[eruption]] ([[polymorphous light eruption]])


*Environmental injury
*Environmental [[injury]]


'''Ear canal:'''  
'''Ear canal:'''  


*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>
*[[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>


*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>
*[[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>


*Contact dermatitis
*[[Contact dermatitis]]


*Furuncle
*[[Furuncle]]


*Foreign body
*[[Foreign body]]


*Cerumen impaction
*[[Cerumen impaction]]


*Tumor
*[[Tumor]]


'''Middle and inner ear:'''  
'''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>
*[[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: 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>,
*[[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
*[[Otitis media]] with effusion


*Eustachian tube dysfunction
*[[Eustachian tube dysfunction]]


*Cholesteatoma
*[[Cholesteatoma]]


*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.
*[[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>   
'''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 lymphadenopathy or lymphadenitis
*[[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>,
*[[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 syndrome,
*[[Temporomandibular joint dysfunction (TMJ)|Temporomandibular joint dysfunction]] syndrome,


*Facial nerve (Bell's) palsy,
*[[Facial nerve palsy|Facial nerve]] ([[Bell's palsy|Bell's]]) [[palsy]],


*Oropharyngeal infections,
*[[Oropharyngeal]] [[Infection|infections]],


*Sinusitis,
*[[Sinusitis]],


*Cervical spine injury
*[[Cervical spine injury]]


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


*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>:
*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>:
*acute otitis media is approximately 83% of children by 3 years of age.
*[[Acute otitis media]] is approximately 83% of [[children]] by 3 years of age.
*Otitis externae peaks at age 7–12 years of age and around 10% of people has had it at least once in their live.
*[[Cerumen impaction]] occurs in 1 out of every 10 [[children]]
*Cerumen impaction occurs in 1 out of every 10 children
   
   
===Age===
===Age===


*Patients of all age groups may develop ear pain.
*[[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.
*ear pain in children especially  primary otalgia of  infection (acute otitis media) is more commonly observed among ages 6–24 months .
   
   
===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 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 risk factors, Diabetes or immunocompromise, smoker or negative smoker(tobacco smoke exposure), Unilateral hearing loss, Superior 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>.
*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==
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>


=='''Natural History, Complications and Prognosis'''==
*[[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 acute otitis media in children is 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>
*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>


:*pain (rubbing, tugging, or holding the ear may be a sign of pain)
:*[[Pain]] (rubbing, tugging, or holding the [[ear]] may be a [[Sign (medical)|sign]] of [[pain]])
:*fever
:*[[Fever]]
:*irritability
:*[[Irritability]]
:*otorrhea
:*[[Otorrhea]]
:*anorexia
:*[[Anorexia]]
:*sometimes vomiting or lethargy
:*Sometimes [[vomiting]] or [[lethargy]]
   
   
===Symptoms===
===Symptoms===


*ear pain in children is usually asymptomatic.
*[[Ear pain]] in [[children]] is sometimes asymptomatic.
*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>
*[[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
*[[Ear pain]], especially when lying down.
*Tugging or pulling at an ear
*Tugging or pulling at an [[ear]].
*Difficulty sleeping
*[[Difficulty sleeping]].
*Crying more than usual
*[[Crying]] more than usual.
*Acting more irritable than usual
*Acting more [[irritable]] than usual.
*Difficulty hearing or responding to sounds
*[[Difficulty hearing]] or responding to [[sound]]<nowiki/>s.
*Loss of balance
*[[Loss of balance]]
*Fever of 100 F (38 C) or higher
*[[Fever]] of 100 F (38 C) or higher.
*Drainage of fluid from the ear
*[[Drainage from the ear|Drainage]] of fluid from the [[ear]].
*Headache
*[[Headache]]
*Loss of appetite
*[[Loss of appetite]].


===Physical Examination===
===Physical Examination===


*Patients of 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="urlUpToDate6">{{cite web |url=https://www.uptodate.com/contents/evaluation-of-earache-in-children?search=Pathophysiology%20ear%20pain&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2 |title=UpToDate |format= |work= |accessdate=}}</ref>
*[[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:<ref name="urlUpToDate5">{{cite web |url=https://www.uptodate.com/contents/evaluation-of-earache-in-children?search=Pathophysiology%20ear%20pain&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2 |title=UpToDate |format= |work= |accessdate=}}</ref>
*[[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>:


:*abnormal vital signs due to serious infection, like meningitis, sepsis, or serious traumatic injury, like epidural hematoma.
:*Abnormal [[vital signs]] due to serious [[infection]], like [[meningitis]], [[sepsis]], or serious [[traumatic injury]], like [[epidural hematoma]].
:*holding their ear and crying in sever otitis media or externa.
:*Holding their [[ear]] and [[crying]] in sever [[otitis media]] or externa.
:*moderate to severe hearing loss
:*Moderate to severe [[hearing loss]].
:*traumatic injury like lacerations, ecchymoses, fluctuant hematomas, or swelling.
:*[[Traumatic injury]] like [[lacerations]], [[ecchymoses]], fluctuant hematomas, or [[swelling]].
:*periorbital ecchymoses Signs of basilar skull fracture.
:*[[Periorbital bruising|Periorbital]] [[ecchymoses]] [[signs]] of [[basilar skull fracture]].
:*Battle sign (ecchymosis overlying the mastoid bone)
:*[[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
:*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
:*Protrusion of the [[ear]] from the side of the [[head]] due to either  [[allergic]] or [[infectious]] [[inflammation]] of the [[pinna]] or [[mastoiditis]].
:*Pre- or postauricular lymphadenopathy presence of any fluctuance and overlying redness or swelling
:*[[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>
[[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 ear pain in children.
*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 .
*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]] .
*Other laboratory findings consistent with the diagnosis of ear pain in children  include [Bacterial or fungal culture of 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.
*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]].


===Electrocardiogram===
===Electrocardiogram===
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.
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]].


===X-ray===
===X-ray===
An x-ray may be helpful in the diagnosis of inner ear . Findings on an x-ray suggestive of microstructures defect  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>.
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>.


===Echocardiography or Ultrasound===
===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<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>.
[[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>.


===CT scan===
===CT scan===
There are no 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 instability, fever, focal neurologic findings, meningismus, and/or severe headache, complications, such as venous sinus thrombosis, meningitis, or brain abscess should be suspected.
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.


===MRI===
===MRI===
Ear MRI( Magnetic resonance imaging) and referral for nasolaryngoscopymay be helpful in the diagnosis of ear pain in childen in the setting of otalgia with normal ear examination findings and symptoms of or risk factors for 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 signals with intensifying in tympanum, , and Long T1 or equal T1 and long T2 signal in mastoid showed obstructive inflammation.
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]].


<br />
<br />


===Other Imaging Findings===
===Other Imaging Findings===
There are no other imaging findings associated with ear pain in children.
There are no other [[imaging]] findings associated with [[ear pain]] in [[children]].


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


*Ear pain in children usually diagnosed using 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 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>
*[[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<ref name="urlUpToDate4">{{cite web |url=https://www.uptodate.com/contents/evaluation-of-earache-in-children?search=Pathophysiology%20ear%20pain&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2 |title=UpToDate |format= |work= |accessdate=}}</ref> on otoscopic examination include  redness, flaking, swelling, or thick discharge<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> of ear canal, presence of masses, foreign bodies, bullae, or eczematous changes, and  the TM appears thickened or cloudy, or if air bubbles are evident behind the TM, a middle ear effusion should be suspected, 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, Perforations of the TM, inserted tympanostomy tube can see location and patency should be assessed, In cases of trauma, hemotympanum may be noted. Hemotympanum is characterized by a red or purple effusion, which may occupy the entire middle ear space or may appear as an air-fluid level.
*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===


*The mainstay of therapy for ear pain in children over-the-counter drugs like Tylenol(acetaminophen) or ibuprofen (Advil, Motrin) and anesthetic drops, 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>. 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>
*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>.
*[[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>.
*[[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>.
*[[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 cholesteatoma (Abnormal squamous epithelium) polypoid disease, and infected bone must be removed in order to create a dry, safe ear that is free of infection<ref name="urlUpToDate7">{{cite web |url=https://www.uptodate.com/contents/chronic-otitis-media-cholesteatoma-and-mastoiditis-in-adults/abstract/11 |title=UpToDate |format= |work= |accessdate=}}</ref>.
*[[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 X-Ray radiation is the most common approach to the treatment of .
*[[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===


*Effective measures for the primary prevention of ear pain in children include Don’t smoke, and avoid 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 objects out of your ears  always take time to carefully dry your ears 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 [[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>


==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.
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  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.
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  56. ↑ "Diagnosis of Ear Pain - American Family Physician".
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  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.
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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.
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  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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