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| '''I.'''[[Otalgia diagnosis#medical therapy|Medical therapy]] | | '''I.'''[[Otalgia diagnosis#medical therapy|Medical therapy]] |
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| '''II.'''[[Otalgia diagnosis#surgical therapy|Surgical therapy]] | | '''II.'''[[Otalgia diagnosis#surgical therapy|Surgical therapy]] |
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| ==Primary otalgia==
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| Ear pain can be caused by disease in the external, [[Middle ear|middle]], or inner ear, but the three are indistinguishable in terms of the pain experienced.
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| '''External''' ear pain may be:
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| * Mechanical: trauma, foreign bodies such as hairs, insects or cotton buds.
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| * Infective (otitis externa): ''[[Staphylococcus]]'', ''[[Pseudomonas]]'', ''[[Candida]]'', [[herpes zoster]], or viral myringitis. (See [[Otitis externa]])
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| '''Middle''' ear pain may be:
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| * Mechanical: [[barotrauma]] (often [[iatrogenic]]), [[Eustachian tube]] obstruction leading to acute [[otitis media]].
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| * Inflammatory / infective: acute otitis media, [[mastoiditis]].
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| ==Secondary otalgia==
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| Ear pain can be referred pain to the ears in five main ways:
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| * Via [[Trigeminal]] nerve [cranial nerve V]. Rarely, trigeminal [[neuralgia]] can cause otalgia.
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| * Via Facial nerve [cranial nerve VII]. This can come from the [[teeth]] (most commonly the upper molars, when it will be worse when drinking cold fluids), the [[temporomandibular]] joint (due to its close relation to the ear canal), or the [[parotid gland]].
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| * Via [[Glossopharyngeal]] nerve [cranial nerve IX]. This comes from the [[oropharynx]], and can be due to [[pharyngitis]] or [[tonsillitis]], or to [[carcinoma]] of the posterior third of the tongue.
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| * Via [[Vagus nerve]] [cranial nerve X]. This comes from the [[laryngopharynx]] in carcinoma of the [[pyriform fossa]] or from the [[esophagus]] in GERD.
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| * Via the second and third [[cervical]] vertebrae, C2 and C3. This ear pain is therefore postural.
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| Psychogenic otalgia is when no cause to the pain in ears can be found, suggesting a functional origin. The patient in such cases should be kept under observation with periodic re-evaluation.
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| ==Diagnosis==
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| It is normally possible to establish the cause of ear pain based on the history. It is important to exclude [[cancer]] where appropriate, particularly with unilateral otalgia in an adult who uses [[tobacco]] or [[alcohol]].<ref>{{cite journal | author = Amundson L | title = Disorders of the external ear. | journal = Prim Care | volume = 17 | issue = 2 | pages = 213-31 | year = 1990 | id = PMID 2196606}}</ref>
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| === Laboratory Findings ===
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| * [[Complete blood count]] (CBC)
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| * Culture of otorrhea
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| === MRI and CT ===
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| * Head CT scan
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| === Other Diagnostic Studies ===
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| * [[Tympanometry]]
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| * [[Audiometry]]
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| == Treatment ==
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| * Warm compress
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| * Physical therapy, dental bite adjustment ([[TMJ]])
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| * Remove foreign bodies with a curette
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| === Pharmacotherapy ===
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| ==== Acute Pharmacotherapies ====
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| * Control pain with [[acetaminophen]], nonsteriodal anti-inflammatory drugs ([[NSAIDs]]), and topical [[benzocaine]] solution
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| * Antibiotics ([[otitis media]], [[otitis externa]], [[pharyngitis]] / [[tonsillitis]])
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| * [[NSAIDs]] for [[TMJ]]
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| * Steroid drops, 8% aluminum acetate +/- 2% acetic acid (otitis externa)
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| * Anti[[staphylococcal]] antibiotics, IV anti[[pseudomonal]] (malignant [[otitis externa]])
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| * Decongestants ([[barotrauma]])
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| ==See also== | | ==See also== |