Tympanic membrane red, but not bulging landmarks visibleīullous myringitis is not pathognomonic of viral myringitis Presentation similar to acute otitis media Often causes chronic otitis media or serous otitisĬonsider testing for antineutrophil cytoplasmic antibodies May require meticulous examination of external auditory canalĭiagnosis of ear canal tumors is often delayed because of misdiagnosis as chronic inflammation Pain usually well localized to auricle or ear canal Tumors or infected cysts in auricle or ear canal Prevalence increased in children with limited access to health care Most common injury is laceration of the auricle Traumatic lesions of auricle, ear canal, or tympanic membrane Recurrent swelling and redness of auricleĮarlobe is spared because it has no cartilageĬan involve other cartilage such as trachea and bronchi Perichondritis must be treated aggressively sometimes requires parenteral antibiotics Perichondritis characterized by persistent redness, swelling, and pain Preceding insect bite, scratch, or piercing Pain can occur without significant vesicular eruption Vesicular rash on auricle and external auditory canalĬan involve other cranial nerves (e.g., V, IX, X ) Patient may have vertigo, hearing loss, or tinnitus Pain often precedes vesicles and is much worse than in Bell's palsy Ramsay Hunt syndrome (herpes zoster oticus) 15, 16 Obtain technetium bone scan to determine extent of disease and gallium tagged white-cell scan as baseline to follow response to treatment Granulation tissue on floor of external auditory canal Pain disproportionate to examination findings Suspect in refractory otitis externa in patients with diabetes, older patients, and those with immunocompromise Malignant (necrotizing) otitis externa 14 * Patients whose history or physical examination increases suspicion for a serious occult cause of ear pain or whose symptoms persist after symptomatic treatment should be considered for further evaluation, such as magnetic resonance imaging, fiberoptic nasolaryngoscopy, or an erythrocyte sedimentation rate measurement. Patients who smoke, drink alcohol, are older than 50 years, or have diabetes are at higher risk of a cause of ear pain that needs further evaluation.
#Pain intensity ear piercing pain chart trial
If the diagnosis is not clear from the history and physical examination, options include a trial of symptomatic treatment without a clear diagnosis imaging studies and consultation with an otolaryngologist. The most common causes are temporomandibular joint syndrome, pharyngitis, dental disease, and cervical spine arthritis. The cause of secondary otalgia is often difficult to determine because the innervation of the ear is complex and there are many potential sources of referred pain. The cause of primary otalgia is usually apparent on examination the most common causes are otitis media and otitis externa. When the ear is not the source of the pain (secondary otalgia), the ear examination is typically normal.
When the ear is the source of the pain (primary otalgia), the ear examination is usually abnormal.
Many patients in primary care present with ear pain (otalgia).
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