RESUMO
Though the vast majority of conditions associated with otalgia are not life-threatening, there are nuances and controversies in the diagnosis and management of even the most common diseases, such as acute otitis media and otitis externa. For more severe disease processes, such as necrotizing otitis externa, acute mastoiditis, and perichondritis, early recognition and timely management are paramount in reducing morbidity and mortality. A systematic approach to the evaluation of these patients is key to establishing an accurate diagnosis, identifying patients who are at high risk for dangerous etiologies or complications, and providing optimal patient care. This issue summarizes the most recent guidelines and presents a systematic, evidence-based approach to the emergency department evaluation and management of patients with otalgia.
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Otite Externa , Otite Média , Humanos , Dor de Orelha/diagnóstico , Dor de Orelha/etiologia , Dor de Orelha/terapia , Otite Externa/complicações , Otite Externa/diagnóstico , Otite Média/complicações , Serviço Hospitalar de Emergência , Doença AgudaRESUMO
OBJECTIVE: To provide family physicians and general otolaryngologists with a practical, evidence-based, and comprehensive approach to the management of patients presenting with suspected referred otalgia. SOURCES OF INFORMATION: The approach described is a review based on the authors' clinical practices along with research and clinical review articles published between 2000 and 2020. MEDLINE and PubMed were searched using the terms otalgia, referred otalgia, and secondary otalgia. Current guidelines for the management of referred otalgia were also reviewed. MAIN MESSAGE: Otalgia is defined as pain localized to the ear. It is one of the most common head and neck presentations in primary care, otolaryngology, and emergency medicine. Secondary otalgia arises from nonotologic pathology and represents nearly 50% of otalgia cases. Otalgia in the absence of other otologic symptoms is highly indicative of a secondary cause. A thorough assessment of patients presenting with referred otalgia requires an understanding of the possible causes of this condition, including dental and oral mucosal pathologies, temporomandibular joint disorders, cervical spine pathology, sinusitis, upper airway infection, and reflux, as well as head and neck malignancy. This paper aims to highlight the most common causes of referred otalgia, their presentations, and initial options for assessment and management. CONCLUSION: The prevalence of referred otalgia makes this an important condition for family physicians to be able to assess, manage, and triage based on patient presentation and examination. Understanding the common causes of referred otalgia will help reduce wait times for specialist assessment and allow ease and speed of access to management options for patients in community clinics.
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Sinusite , Transtornos da Articulação Temporomandibular , Humanos , Dor de Orelha/diagnóstico , Dor de Orelha/etiologia , Dor de Orelha/terapia , Orelha , Transtornos da Articulação Temporomandibular/complicações , PescoçoRESUMO
Glossopharyngeal neuralgia (GPN) is an uncommon facial pain syndrome and is characterized by paroxysms of excruciating pain in the distributions of the auricular and pharyngeal branches of cranial nerves IX and X. Glossopharyngeal neuralgia characterized by otalgia alone is rare. Herein, the authors analyzed 2 patients with GPN with otalgia as the main clinical manifestation. The clinical features and prognosis of this rare group of patients with GPN were discussed. They both presented with paroxysmal pain in the external auditory meatus and preoperative magnetic resonance imaging suggested the vertebral artery were closely related to the glossopharyngeal nerves. In both patients, compression of the glossopharyngeal nerve was confirmed during microvascular decompression, and the symptoms were relieved immediately after surgery. At 11 to 15 months follow-up, there was no recurrence of pain. A variety of reasons can cause otalgia. The possibility of GPN is a clinical concern in patients with otalgia as the main complaint. The authors think the involvement of the glossopharyngeal nerve fibers in the tympanic plexus via Jacobson nerve may provide an important anatomic basis for GPN with predominant otalgia. Surface anesthesia test of the pharynx and preoperative magnetic resonance imaging is helpful for diagnosis. Microvascular decompression is effective in the treatment of GPN with predominant otalgia.
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Doenças do Nervo Glossofaríngeo , Cirurgia de Descompressão Microvascular , Humanos , Estudos Retrospectivos , Dor de Orelha/diagnóstico , Dor de Orelha/etiologia , Doenças do Nervo Glossofaríngeo/diagnóstico por imagem , Doenças do Nervo Glossofaríngeo/cirurgia , Nervo Glossofaríngeo/cirurgia , Dor/etiologia , Cirurgia de Descompressão Microvascular/efeitos adversosRESUMO
Earache, or otalgia, in children is common. Diagnosis can be challenging due to the range of causes. Assessment involves a thorough history and examination. Identification of associated otological symptoms, including discharge, hearing loss, vertigo and facial nerve weakness, is helpful and can aid diagnosis. Examination should involve looking at the external ear, otoscopy to assess the ear canal and tympanic membrane and documentation of facial nerve function. If otological examination is normal, further examination looking for non-otological causes may be guided by the history. Investigations are often unnecessary but may include blood tests, audiology and imaging. Most otalgia is caused by an acute infection, which is self-limiting and can be managed in the community. However, ear, nose and throat (ENT) advice and input may be required for systemically unwell children or those who fail to improve despite appropriate medical therapy.
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Dor de Orelha , Vertigem , Humanos , Criança , Dor de Orelha/diagnóstico , Dor de Orelha/etiologia , Dor de Orelha/terapia , Vertigem/etiologiaRESUMO
BACKGROUND: Acute otitis media (AOM) is one of the most common childhood infections. Ear pain, the main symptom of AOM, results in parents frequently seeking medical assistance for their children. The aim of this study was to compare the effectiveness of topical 1% lidocaine ear drops administered with oral analgesics with that of oral analgesics alone. METHODS: This multicenter randomized, open-labeled study was conducted at 15 centers with 184 pediatric AOM patients with bilateral ear pain (aged 1-5 years) between May 1, 2016, and June 31, 2018. All patients received oral paracetamol or ibuprofen and topical 1% lidocaine, which was administered to each ear according to the randomization list. The ear pain score was evaluated within 48 h using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale, and the patients were followed up for 10 days. RESULTS: The median age was 31.8 months (min-max, 12-84.2 months). Of those patients enrolled, 22.3% received paracetamol, and 24.5% received paracetamol with lidocaine ear drops; 23.4% received ibuprofen, and 29.9% received ibuprofen with lidocaine ear drops. Lower pain scores were significantly measured at baseline and 10th minutes by a reduction 25% (RR 13.64, 95% CI 4.47-41.63, p = 0.001, RR 0.14, 95% CI 0.06-0.35, p = 0.001) and 50% (RR 4.76, 95% CI 1.63-13.87, p = 0.004, RR 0.14, 95% CI 0.05-0.4, p = 0.001) in the paracetamol and lidocaine versus paracetamol groups and the ibuprofen and lidocaine versus ibuprofen groups, respectively. No serious side effects were evident during follow-up. CONCLUSION: This randomized study suggests that topical 1% lidocaine ear drops with paracetamol or ibuprofen seems to provide effective and rapid relief for children presenting with ear pain attributed to AOM.
Assuntos
Acetaminofen , Otite Média , Acetaminofen/uso terapêutico , Doença Aguda , Analgésicos/uso terapêutico , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Dor de Orelha/diagnóstico , Dor de Orelha/tratamento farmacológico , Dor de Orelha/etiologia , Humanos , Ibuprofeno/uso terapêutico , Lidocaína/uso terapêutico , Otite Média/complicações , Otite Média/tratamento farmacológico , Dor/tratamento farmacológicoAssuntos
Acetaminofen/uso terapêutico , Analgésicos não Narcóticos/uso terapêutico , Antibacterianos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Dor de Orelha/tratamento farmacológico , Ibuprofeno/uso terapêutico , Otite Média/tratamento farmacológico , Acetaminofen/efeitos adversos , Fatores Etários , Analgésicos não Narcóticos/efeitos adversos , Antibacterianos/efeitos adversos , Anti-Inflamatórios não Esteroides/efeitos adversos , Dor de Orelha/diagnóstico , Dor de Orelha/microbiologia , Humanos , Ibuprofeno/efeitos adversos , Otite Média/diagnóstico , Otite Média/microbiologia , Resultado do TratamentoRESUMO
Otalgia can be broadly categorized into primary otologic causes and secondary nonotologic causes. Isolated otalgia in the absence of hearing loss, otorrhea, or abnormal otoscopic findings is typically secondary to referred pain from nonotologic causes, as the sensory nerve supply to the ear arises from 4 cranial nerves and the cervical plexus. The most common causes of primary otalgia are acute otitis media and otitis externa, whereas the most common causes of secondary otalgia are temporomandibular joint disorders and dental pathology. Persistent unilateral ear pain and other alarm symptoms warrant further evaluation for possible neoplasm.
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Dor de Orelha/patologia , Dor de Orelha/terapia , Dor de Orelha/diagnóstico , Dor de Orelha/etiologia , Humanos , Otite Média com Derrame/patologia , Atenção Primária à Saúde , Transtornos da Articulação Temporomandibular/patologiaRESUMO
PURPOSE OF REVIEW: This article reviews the causes of tinnitus, hyperacusis, and otalgia, as well as hearing loss relevant for clinicians in the field of neurology. RECENT FINDINGS: Important causes of unilateral and bilateral tinnitus are discussed, including those that are treatable or caused by serious structural or vascular causes. Concepts of hyperacusis and misophonia are covered, along with various types of neurologic disorders that can lead to pain in the ear. Hearing loss is common but not always purely otologic. SUMMARY: Tinnitus and hearing loss are common symptoms that are sometimes related to a primary neurologic disorder. This review, tailored to neurologists who care for patients who may be referred to or encountered in neurology practice, provides information on hearing disorders, how to recognize when a neurologic process may be involved, and when to refer to otolaryngology or other specialists.
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Perda Auditiva , Zumbido , Dor de Orelha/diagnóstico , Dor de Orelha/etiologia , Perda Auditiva/diagnóstico , Humanos , Hiperacusia/diagnóstico , Zumbido/diagnóstico , Zumbido/etiologia , Zumbido/terapiaRESUMO
AIM: We aimed to describe otogenic lateral sinovenous thrombosis (OLST), a rare, potentially life-threatening complication of otomastoiditis. METHODS: Children diagnosed with OLST in a tertiary-care Hospital from 2014 to 2019 was retrospectively selected. Clinical and radiological features, timing of diagnosis, treatment and outcome are reported. RESULTS: Seven children (5 males) were studied. Fever and neurological symptoms (headache, lethargy, diplopia, dizziness and papilledema) were always present. Otalgia and/or otorrhea were found in 6 children; none had signs of mastoiditis. Diagnosis was reached after 7 days (median) from clinical onset. Brain CT-scan was performed in 5 children being diagnostic for 3. Venography-MRI detected OLST and mastoiditis in all cases without parenchymal lesions. Treatment was based on intravenous rehydration, antibiotic and low-molecular weight heparin; acetazolamide was added in 3 children. Mastoidectomy and ventriculoperitoneal-shunting were selectively performed. Patients were discharged after 26 days (median). Follow-up neuroimaging showed sinus recanalization after a median time of 6 months. CONCLUSION: A multidisciplinary approach is needed to optimize diagnostic-therapeutic protocols of pediatric OLST.
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Otorreia de Líquido Cefalorraquidiano/complicações , Dor de Orelha/complicações , Trombose do Seio Lateral/etiologia , Mastoidite/complicações , Adolescente , Fatores Etários , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Inibidores da Anidrase Carbônica/uso terapêutico , Otorreia de Líquido Cefalorraquidiano/diagnóstico , Otorreia de Líquido Cefalorraquidiano/terapia , Criança , Pré-Escolar , Dor de Orelha/diagnóstico , Dor de Orelha/terapia , Feminino , Hidratação , Humanos , Trombose do Seio Lateral/diagnóstico por imagem , Trombose do Seio Lateral/terapia , Masculino , Mastoidectomia , Mastoidite/diagnóstico , Mastoidite/terapia , Estudos Retrospectivos , Resultado do Tratamento , Derivação VentriculoperitonealRESUMO
Since late December 2019, a new type of coronavirus (CIVID-19) causing a cluster of respiratory infections was first identified in Wuhan-China. And it disseminated to all countries. Generally, COVID-19 cases have fever, cough, respiratory distress findings (dyspnoea, intercostal retraction, cyanosis etc.). In this paper, we have presented an adult otitis media case whom infected with COVID-19, but she have not any classical COVID-19 symptoms.
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Antivirais/uso terapêutico , Doenças Assintomáticas , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Perda Auditiva Neurossensorial/diagnóstico , Otite Média/diagnóstico , Pneumonia Viral/diagnóstico , Testes de Impedância Acústica/métodos , Audiometria/métodos , COVID-19 , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Dor de Orelha/diagnóstico , Dor de Orelha/etiologia , Feminino , Seguimentos , Perda Auditiva Neurossensorial/etiologia , Humanos , Otite Média/etiologia , Otite Média/terapia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Radiografia Torácica/métodos , Medição de Risco , SARS-CoV-2 , Resultado do Tratamento , Adulto JovemRESUMO
INTRODUCTION: Necrotizing otitis externa resolves best with antimicrobial treatment. How to care for these patients and monitor their resolution remains a problem. Our protocol in Bangalore can manage these patients inexpensively and well. MATERIALS AND METHODS: Patients who were referred to our patients became the subjects for this paper. They were managed through our protocol, which consists of IV ciprofloxacin and meropenem, weekly labs, weekly examinations, and photodocumention. RESULTS: Fifty-one people presented with necrotizing otitis externa (NOE) between October 2015 and November 2017 and completed our entire protocol. Forty-six had complete resolution of their disease, while 5 had to undergo surgical removal of necrotic bone. Six of 8 patients with facial weakness had improvement in their House-Brackmann scores. Reduction of self-reported nocturnal pain, dissolution of ear canal granulations, and normalization of the erythrocyte sedimentation rate (ESR) proved to be the most accurate indicators of disease regression. CONCLUSION: Patients are monitored closely with review of their otalgia, examination of their canal, repeated ESRs, effective control of their diabetes, and radiological imaging. All this can be done in a resource-poor country, which in turn serves as a model for the wealthier nations.
Assuntos
Ciprofloxacina/administração & dosagem , Dor de Orelha , Meropeném/administração & dosagem , Osteomielite , Otite Externa , Antibacterianos/administração & dosagem , Dor de Orelha/diagnóstico , Dor de Orelha/tratamento farmacológico , Dor de Orelha/etiologia , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Necrose , Osteomielite/diagnóstico , Osteomielite/etiologia , Osteomielite/cirurgia , Otite Externa/tratamento farmacológico , Otite Externa/patologia , Otite Externa/fisiopatologia , Otite Externa/cirurgia , Base do Crânio/diagnóstico por imagem , Base do Crânio/patologia , Resultado do TratamentoRESUMO
Angioleiomyomas (ALMAs) are benign tumors that arise from smooth muscle cells that form the tunica media of vascular structures. To our knowledge, only five cases of ALMA of the external auditory canal (EAC) have been reported. We report the case of a 52-year-old man with left otalgia, otorrhea, auricular fullness, and hearing loss. On otomicroscopic examination, a reddish and smooth mass completely occluding the EAC was seen. Computed tomography scan showed a soft tissue mass with a complete opacification of the left EAC. A possible diagnosis of ALMA should be considered when finding a tumor inside the external ear canal. An accurate pathological examination should be performed to differentiate benign vascular ALMA from malignant leiomyosarcomas. Complete surgical excision is the treatment of choice in benign tumors.
Assuntos
Meato Acústico Externo/patologia , Meato Acústico Externo/ultraestrutura , Leiomioma/cirurgia , Audiometria de Tons Puros/métodos , Diagnóstico Diferencial , Meato Acústico Externo/diagnóstico por imagem , Otopatias/patologia , Neoplasias da Orelha/patologia , Dor de Orelha/diagnóstico , Perda Auditiva Condutiva/diagnóstico , Perda Auditiva Condutiva/etiologia , Perda Auditiva Condutiva/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
Necrotising otitis externa (NOE) is an infection originating in the soft tissues of the external auditory canal (EAC) spreading to the surrounding bone and rarely causing intracranial complications. It is usually caused by Pseudomonas aeruginosa and has historically occurred in elderly patients with diabetes or immunodeficiency. EAC foreign body is a risk factor for otitis externa but has not been described in NOE. A healthy 31-year-old man presented with new-onset seizures and worsening left-sided otalgia and otorrhoea. Brain imaging revealed left temporal subdural abscesses superior to the petrous bone. A retained cotton bud was identified in the left EAC, along with osseocartilaginous junction and mastoid granulation tissue. The foreign body was removed; a cortical mastoidectomy performed and intravenous antibiotic administered. At 10 weeks, the patient remained well, with no neurological deficit and no residual ear symptoms, and CT demonstrated complete resolution of the intracranial abscesses.
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Meato Acústico Externo/microbiologia , Empiema Subdural/etiologia , Otite Externa/microbiologia , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Meato Acústico Externo/patologia , Otopatias/complicações , Dor de Orelha/diagnóstico , Empiema Subdural/diagnóstico por imagem , Empiema Subdural/tratamento farmacológico , Corpos Estranhos , Tecido de Granulação , Humanos , Masculino , Processo Mastoide/patologia , Processo Mastoide/cirurgia , Mastoidectomia/métodos , Necrose/patologia , Otite Externa/diagnóstico , Otite Externa/tratamento farmacológico , Otite Externa/patologia , Convulsões/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
BACKGROUND: The assessment of ear pain is challenging in young, mostly preverbal children. Our aim was to investigate whether pain scales are useful tools for parents to detect pain in their young children with the suspicion of acute otitis media (AOM), and to assess associations between 16 symptoms and the severity of pain. METHODS: This cross-sectional study included 426 children (6-35 months) with symptoms suggestive of AOM. We surveyed symptoms and pain via parental interview. As part of the interview, parents assessed their child's pain by using two pain scales: The Faces Pain Scale-Revised (FPS-R) and the Face, Legs, Activity, Cry, Consolability (FLACC) Scale. The outcome of interest was moderate/severe pain. We used the χ2 test or Fisher's test as applicable to compare the severity of pain between three parental pain assessment methods (the parental interview, the FPS-R and the FLACC Scale). We also used multivariable logistic regression models to study the association between the severity of pain and AOM and to study the association between symptoms and the severity of pain. RESULTS: In children with AOM (n = 201), pain was assessed by parents as moderate/severe in 65% via interview; 90% with the FPS-R; and 91% with the FLACC Scale (P < 0.001). In children without AOM (n = 225), the percentages were 56, 83 and 88%, respectively (P < 0.001). Between children with and without AOM, the occurrence of moderate/severe pain did not differ with any of the pain evaluation methods. Of symptoms, ear pain reported by child and restless sleep were significantly associated with moderate/severe pain, regardless of the pain evaluation method. CONCLUSIONS: It seems that nearly all the children with respiratory tract infection, either with or without AOM, might suffer from moderate/severe pain. Without pain scales, parents may underestimate their child's pain. Of symptoms, ear pain reported by child and restless sleep might indicate pain in children with respiratory tract infection. We suggest that the adaptation of pain scales for parent observation is a possibility in children with respiratory tract infection which, however, requires further studies. TRIAL REGISTRATION: www.clinicaltrials.gov , identifier NCT00299455 . Date of registration: March 3, 2006.
Assuntos
Dor de Orelha/diagnóstico , Otite Média/complicações , Medição da Dor/métodos , Pais , Pré-Escolar , Estudos Transversais , Dor de Orelha/etiologia , Feminino , Humanos , Lactente , Masculino , Otite Média/diagnóstico , Infecções Respiratórias/complicações , Infecções Respiratórias/diagnóstico , Índice de Gravidade de Doença , Transtornos do Sono-Vigília/etiologiaRESUMO
BACKGROUND: Whilst current guidelines highlight the importance of pain management for children with acute otitis media (AOM), there is evidence to suggest that this is not implemented in everyday practice. We have developed a primary care-based multifaceted educational intervention to optimise pain management in children with AOM, and we trial its clinical and cost effectiveness. METHODS: This cluster randomised controlled trial aims to recruit 250 children aged 6 months to 10 years presenting with AOM to general practitioners (GPs) in 30 primary care centres (PCCs) across the Netherlands. GPs in the PCCs allocated to the intervention group receive a blended GP educational programme (online and face-to-face training). The intervention asks GPs to proactively discuss pain management with parents using an information leaflet, and to prescribe paracetamol and ibuprofen according to current guidelines. GPs in both groups complete an online module illustrating various otoscopic images to standardise AOM diagnosis. GPs in the PCCs allocated to the control group do not receive any further training and provide 'care as usual'. During the 4-week follow-up, parents complete a symptom diary. The primary outcome is the difference in parent-reported mean earache scores over the first 3 days. Secondary outcomes include both number of days with earache and fever, GP re-consultations for AOM, antibiotic prescriptions, and costs. Analysis will be by intention-to-treat. DISCUSSION: The optimal use of analgesics through the multifaceted intervention may provide symptom relief and thereby reduce re-consultations and antibiotic prescriptions in children with AOM. TRIAL REGISTRATION: Netherlands Trial Register, NTR4920 . Registered on 19 December 2014.
Assuntos
Dor Aguda/terapia , Dor de Orelha/terapia , Conhecimentos, Atitudes e Prática em Saúde , Otite Média/terapia , Manejo da Dor/métodos , Pais/educação , Atenção Primária à Saúde/métodos , Acetaminofen/uso terapêutico , Dor Aguda/diagnóstico , Dor Aguda/economia , Dor Aguda/etiologia , Fatores Etários , Analgésicos não Narcóticos/uso terapêutico , Criança , Pré-Escolar , Análise Custo-Benefício , Inibidores de Ciclo-Oxigenase/uso terapêutico , Dor de Orelha/diagnóstico , Dor de Orelha/economia , Dor de Orelha/etiologia , Feminino , Custos de Cuidados de Saúde , Humanos , Ibuprofeno/uso terapêutico , Lactente , Masculino , Estudos Multicêntricos como Assunto , Países Baixos , Otite Média/complicações , Otite Média/diagnóstico , Otite Média/economia , Manejo da Dor/economia , Medição da Dor , Folhetos , Pais/psicologia , Atenção Primária à Saúde/economia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do TratamentoRESUMO
The objective of the present study was to elucidate the specific features of the clinical course of acute otitis media as well as the peculiarities of the vestibular function and the microbial paysage associated with this pathological condition under the present-day conditions. The study included 135 patients presenting with acute otitis media (AOM) at different stages of the disease. The discharge obtained from the tympanic cavity of all the patients was examined with the use of polymerase chain reaction in real time, audiological and vestibulogical methods. The distinctive features of acute otitis medium associated with Streptococcus pneumoniae infection were found to be the intense pain syndrome with the symptoms of intoxication, well apparent inflammatory changes in the tympanic membrane as revealed by otoscopy, the increased frequency of sensorineural impairment of hearing, and the characteristic type B tympanometric curve. Typical of AOM associated with Haemophilus influenza infection are the mild pain syndrome, weak changes in the tympanic membrane as revealed by otoscopy, conductive hearing loss, and the type C tympanometric curve.
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Dor de Orelha , Perda Auditiva Neurossensorial , Otite Média , Infecções Pneumocócicas , Doença Aguda , Adulto , Audiometria/métodos , Dor de Orelha/diagnóstico , Dor de Orelha/etiologia , Feminino , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/etiologia , Perda Auditiva Neurossensorial/fisiopatologia , Humanos , Masculino , Otite Média/diagnóstico , Otite Média/microbiologia , Otite Média/fisiopatologia , Gravidade do Paciente , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/fisiopatologia , Streptococcus pneumoniae/isolamento & purificação , Testes de Função Vestibular/métodosRESUMO
Otalgia (ear pain) is a common presentation in the primary care setting with many diverse causes. Pain that originates from the ear is called primary otalgia, and the most common causes are otitis media and otitis externa. Examination of the ear usually reveals abnormal findings in patients with primary otalgia. Pain that originates outside the ear is called secondary otalgia, and the etiology can be difficult to establish because of the complex innervation of the ear. The most common causes of secondary otalgia include temporomandibular joint syndrome and dental infections. Primary otalgia is more common in children, whereas secondary otalgia is more common in adults. History and physical examination usually lead to the underlying cause; however, if the diagnosis is not immediately clear, a trial of symptomatic treatment, imaging studies, and consultation may be reasonable options. Otalgia may be the only presenting symptom in several serious conditions, such as temporal arteritis and malignant neoplasms. When risk factors for malignancy are present (e.g., smoking, alcohol use, diabetes mellitus, age 50 years or older), computed tomography, magnetic resonance imaging, or otolaryngology consultation may be warranted.
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Dor de Orelha/diagnóstico , Medição da Dor , Exame Físico , Adulto , Criança , Técnicas de Diagnóstico Otológico , Dor de Orelha/terapia , Humanos , Masculino , Periodontite/complicações , Índice de Gravidade de Doença , Transtornos da Articulação Temporomandibular/complicações , Doenças Dentárias/complicaçõesAssuntos
Dor de Orelha/diagnóstico , Dor de Orelha/etiologia , Otolaringologia , Seleção de Pacientes , Encaminhamento e Consulta , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Dor de Orelha/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: The purpose of this study was to analyze the correlation between the pathology and clinical presentations in patients with adenoid cystic carcinoma (ACC) of the external auditory canal. METHODS: Twenty-nine patients with ACC of the external auditory canal who underwent surgery were retrospectively reviewed. RESULTS: Fifty percent of patients with solid pattern disease had recurrences, followed by those with cribriform (33%) and tubular (0%) pattern. Perineural invasion was common (55%), and occurred most frequently in the solid subtype (67%). The rate of otalgia was less in patients with perineural invasion (31% vs 46%). Most tumors (59%) involved the parotid gland, but it was not seen on preoperative MRI (35%). CONCLUSION: The solid subtype presents the worst prognosis, and is prone to perineural invasion. Despite frequently occurring in ACC of the external auditory canal, perineural invasion may not be associated with otalgia. In ACC of the external auditory canal, high rates of occult parotid involvement support adjunctive superficial parotidectomy.