Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 173
Filter
1.
Emerg Med Pract ; 26(4): 1-28, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38507217

ABSTRACT

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.


Subject(s)
Otitis Externa , Otitis Media , Humans , Earache/diagnosis , Earache/etiology , Earache/therapy , Otitis Externa/complications , Otitis Externa/diagnosis , Otitis Media/complications , Emergency Service, Hospital , Acute Disease
2.
Can Fam Physician ; 69(11): 757-761, 2023 11.
Article in English | MEDLINE | ID: mdl-37963787

ABSTRACT

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.


Subject(s)
Sinusitis , Temporomandibular Joint Disorders , Humans , Earache/diagnosis , Earache/etiology , Earache/therapy , Ear , Temporomandibular Joint Disorders/complications , Neck
3.
J Craniofac Surg ; 34(8): e739-e743, 2023.
Article in English | MEDLINE | ID: mdl-37418618

ABSTRACT

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.


Subject(s)
Glossopharyngeal Nerve Diseases , Microvascular Decompression Surgery , Humans , Retrospective Studies , Earache/diagnosis , Earache/etiology , Glossopharyngeal Nerve Diseases/diagnostic imaging , Glossopharyngeal Nerve Diseases/surgery , Glossopharyngeal Nerve/surgery , Pain/etiology , Microvascular Decompression Surgery/adverse effects
4.
Arch Dis Child Educ Pract Ed ; 108(1): 2-9, 2023 02.
Article in English | MEDLINE | ID: mdl-34580153

ABSTRACT

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.


Subject(s)
Earache , Vertigo , Humans , Child , Earache/diagnosis , Earache/etiology , Earache/therapy , Vertigo/etiology
5.
Int J Pediatr Otorhinolaryngol ; 156: 111116, 2022 May.
Article in English | MEDLINE | ID: mdl-35325846

ABSTRACT

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.


Subject(s)
Acetaminophen , Otitis Media , Acetaminophen/therapeutic use , Acute Disease , Analgesics/therapeutic use , Anti-Bacterial Agents/therapeutic use , Child , Child, Preschool , Earache/diagnosis , Earache/drug therapy , Earache/etiology , Humans , Ibuprofen/therapeutic use , Lidocaine/therapeutic use , Otitis Media/complications , Otitis Media/drug therapy , Pain/drug therapy
7.
Med Clin North Am ; 105(5): 813-826, 2021 Sep.
Article in English | MEDLINE | ID: mdl-34391535

ABSTRACT

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.


Subject(s)
Earache/pathology , Earache/therapy , Earache/diagnosis , Earache/etiology , Humans , Otitis Media with Effusion/pathology , Primary Health Care , Temporomandibular Joint Disorders/pathology
8.
Continuum (Minneap Minn) ; 27(2): 491-525, 2021 04 01.
Article in English | MEDLINE | ID: mdl-34351116

ABSTRACT

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.


Subject(s)
Hearing Loss , Tinnitus , Earache/diagnosis , Earache/etiology , Hearing Loss/diagnosis , Humans , Hyperacusis/diagnosis , Tinnitus/diagnosis , Tinnitus/etiology , Tinnitus/therapy
9.
J Stroke Cerebrovasc Dis ; 29(10): 105184, 2020 Oct.
Article in English | MEDLINE | ID: mdl-32912560

ABSTRACT

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.


Subject(s)
Cerebrospinal Fluid Otorrhea/complications , Earache/complications , Lateral Sinus Thrombosis/etiology , Mastoiditis/complications , Adolescent , Age Factors , Anti-Bacterial Agents/therapeutic use , Anticoagulants/therapeutic use , Carbonic Anhydrase Inhibitors/therapeutic use , Cerebrospinal Fluid Otorrhea/diagnosis , Cerebrospinal Fluid Otorrhea/therapy , Child , Child, Preschool , Earache/diagnosis , Earache/therapy , Female , Fluid Therapy , Humans , Lateral Sinus Thrombosis/diagnostic imaging , Lateral Sinus Thrombosis/therapy , Male , Mastoidectomy , Mastoiditis/diagnosis , Mastoiditis/therapy , Retrospective Studies , Treatment Outcome , Ventriculoperitoneal Shunt
10.
Am J Otolaryngol ; 41(3): 102487, 2020.
Article in English | MEDLINE | ID: mdl-32336572

ABSTRACT

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.


Subject(s)
Antiviral Agents/therapeutic use , Asymptomatic Diseases , Betacoronavirus , Coronavirus Infections/diagnosis , Hearing Loss, Sensorineural/diagnosis , Otitis Media/diagnosis , Pneumonia, Viral/diagnosis , Acoustic Impedance Tests/methods , Audiometry/methods , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/drug therapy , Earache/diagnosis , Earache/etiology , Female , Follow-Up Studies , Hearing Loss, Sensorineural/etiology , Humans , Otitis Media/etiology , Otitis Media/therapy , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/drug therapy , Radiography, Thoracic/methods , Risk Assessment , SARS-CoV-2 , Treatment Outcome , Young Adult
11.
Ann Otol Rhinol Laryngol ; 128(9): 848-854, 2019 Sep.
Article in English | MEDLINE | ID: mdl-31043072

ABSTRACT

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.


Subject(s)
Ciprofloxacin/administration & dosage , Earache , Meropenem/administration & dosage , Osteomyelitis , Otitis Externa , Anti-Bacterial Agents/administration & dosage , Earache/diagnosis , Earache/drug therapy , Earache/etiology , Female , Humans , India , Male , Middle Aged , Necrosis , Osteomyelitis/diagnosis , Osteomyelitis/etiology , Osteomyelitis/surgery , Otitis Externa/drug therapy , Otitis Externa/pathology , Otitis Externa/physiopathology , Otitis Externa/surgery , Skull Base/diagnostic imaging , Skull Base/pathology , Treatment Outcome
12.
J Int Adv Otol ; 15(1): 169-172, 2019 Apr.
Article in English | MEDLINE | ID: mdl-30924774

ABSTRACT

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.


Subject(s)
Ear Canal/pathology , Ear Canal/ultrastructure , Leiomyoma/surgery , Audiometry, Pure-Tone/methods , Diagnosis, Differential , Ear Canal/diagnostic imaging , Ear Diseases/pathology , Ear Neoplasms/pathology , Earache/diagnosis , Hearing Loss, Conductive/diagnosis , Hearing Loss, Conductive/etiology , Hearing Loss, Conductive/physiopathology , Humans , Male , Middle Aged , Tomography, X-Ray Computed/methods , Treatment Outcome
13.
BMJ Case Rep ; 12(3)2019 Mar 06.
Article in English | MEDLINE | ID: mdl-30846453

ABSTRACT

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.


Subject(s)
Ear Canal/microbiology , Empyema, Subdural/etiology , Otitis Externa/microbiology , Adult , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Ear Canal/pathology , Ear Diseases/complications , Earache/diagnosis , Empyema, Subdural/diagnostic imaging , Empyema, Subdural/drug therapy , Foreign Bodies , Granulation Tissue , Humans , Male , Mastoid/pathology , Mastoid/surgery , Mastoidectomy/methods , Necrosis/pathology , Otitis Externa/diagnosis , Otitis Externa/drug therapy , Otitis Externa/pathology , Seizures/diagnosis , Tomography, X-Ray Computed/methods , Treatment Outcome
14.
BMC Pediatr ; 18(1): 392, 2018 12 20.
Article in English | MEDLINE | ID: mdl-30572868

ABSTRACT

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.


Subject(s)
Earache/diagnosis , Otitis Media/complications , Pain Measurement/methods , Parents , Child, Preschool , Cross-Sectional Studies , Earache/etiology , Female , Humans , Infant , Male , Otitis Media/diagnosis , Respiratory Tract Infections/complications , Respiratory Tract Infections/diagnosis , Severity of Illness Index , Sleep Wake Disorders/etiology
15.
Trials ; 19(1): 501, 2018 Sep 17.
Article in English | MEDLINE | ID: mdl-30223903

ABSTRACT

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.


Subject(s)
Acute Pain/therapy , Earache/therapy , Health Knowledge, Attitudes, Practice , Otitis Media/therapy , Pain Management/methods , Parents/education , Primary Health Care/methods , Acetaminophen/therapeutic use , Acute Pain/diagnosis , Acute Pain/economics , Acute Pain/etiology , Age Factors , Analgesics, Non-Narcotic/therapeutic use , Child , Child, Preschool , Cost-Benefit Analysis , Cyclooxygenase Inhibitors/therapeutic use , Earache/diagnosis , Earache/economics , Earache/etiology , Female , Health Care Costs , Humans , Ibuprofen/therapeutic use , Infant , Male , Multicenter Studies as Topic , Netherlands , Otitis Media/complications , Otitis Media/diagnosis , Otitis Media/economics , Pain Management/economics , Pain Measurement , Pamphlets , Parents/psychology , Primary Health Care/economics , Randomized Controlled Trials as Topic , Time Factors , Treatment Outcome
16.
Laryngorhinootologie ; 97(7): 509-510, 2018 Jul.
Article in German | MEDLINE | ID: mdl-29986369
17.
Vestn Otorinolaringol ; 83(1): 36-39, 2018.
Article in Russian | MEDLINE | ID: mdl-29488494

ABSTRACT

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.


Subject(s)
Earache , Hearing Loss, Sensorineural , Otitis Media , Pneumococcal Infections , Acute Disease , Adult , Audiometry/methods , Earache/diagnosis , Earache/etiology , Female , Hearing Loss, Sensorineural/diagnosis , Hearing Loss, Sensorineural/etiology , Hearing Loss, Sensorineural/physiopathology , Humans , Male , Otitis Media/diagnosis , Otitis Media/microbiology , Otitis Media/physiopathology , Patient Acuity , Pneumococcal Infections/diagnosis , Pneumococcal Infections/physiopathology , Streptococcus pneumoniae/isolation & purification , Vestibular Function Tests/methods
18.
Am Fam Physician ; 97(1): 20-27, 2018 01 01.
Article in English | MEDLINE | ID: mdl-29365233

ABSTRACT

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.


Subject(s)
Earache/diagnosis , Pain Measurement , Physical Examination , Adult , Child , Diagnostic Techniques, Otological , Earache/therapy , Humans , Male , Periodontitis/complications , Severity of Illness Index , Temporomandibular Joint Disorders/complications , Tooth Diseases/complications
20.
Head Neck ; 39(12): 2444-2449, 2017 12.
Article in English | MEDLINE | ID: mdl-28963786

ABSTRACT

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.


Subject(s)
Carcinoma, Adenoid Cystic/mortality , Carcinoma, Adenoid Cystic/pathology , Ear Neoplasms/mortality , Ear Neoplasms/pathology , Adult , Aged , Biopsy, Needle , Carcinoma, Adenoid Cystic/diagnostic imaging , Carcinoma, Adenoid Cystic/surgery , Cohort Studies , Disease-Free Survival , Ear Canal/diagnostic imaging , Ear Canal/pathology , Ear Canal/surgery , Ear Neoplasms/diagnostic imaging , Ear Neoplasms/surgery , Earache/diagnosis , Earache/etiology , Female , Humans , Immunohistochemistry , Magnetic Resonance Imaging/methods , Male , Middle Aged , Neoplasm Invasiveness/pathology , Neoplasm Recurrence, Local/mortality , Neoplasm Recurrence, Local/pathology , Neoplasm Staging , Prognosis , Retrospective Studies , Risk Assessment , Survival Analysis
SELECTION OF CITATIONS
SEARCH DETAIL