Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 81
Filtrar
1.
Trials ; 19(1): 501, 2018 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-30223903

RESUMO

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 Entorpecentes/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 Tratamento
3.
Am Fam Physician ; 97(1): 20-27, 2018 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29365233

RESUMO

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.


Assuntos
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/complicações
4.
Aust Fam Physician ; 45(7): 493-7, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27610432

RESUMO

BACKGROUND: Otalgia is frequently seen in general practice. It can be broadly divided into primary otalgia, which includes the diseases occurring largely within the ear, or secondary otalgia, which is pain referred to the ear by travelling along cranial nerves that supply both the ear and referred region. The causes of secondary otalgia may require more extensive examination and investigation to define the aetiology. OBJECTIVE: The aims of this article are to outline the most common causes of otalgia seen in general practice, and provide a pragmatic approach to initial assessment and deciding when to refer for specialist review. DISCUSSION: The most common cause of primary otalgia is infection. Other causes require a greater index of suspicion. Specialist referral could be made if there are complications of primary otalgia or if a secondary cause needs to be excluded in a patient with a normal otology examination.


Assuntos
Gerenciamento Clínico , Dor de Orelha/diagnóstico , Dor de Orelha/patologia , Dor de Orelha/terapia , Feminino , Humanos , Adulto Jovem
5.
Otolaryngol Head Neck Surg ; 154(2): 215-25, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26833646

RESUMO

OBJECTIVE: This plain language summary serves as an overview in explaining otitis media with effusion (pronounced Oh-TIE-tis ME-dee-uh with Ef-YOO-zhun), abbreviated "OME" and often called "ear fluid." The summary applies to children aged 2 months through 12 years with OME and is based on the 2015 "Clinical Practice Guideline: Otitis Media with Effusion (Update)." The evidence-based guideline includes research to support more effective diagnosis and treatment of OME in children. The guideline was developed as a quality improvement opportunity for managing OME by creating clear recommendations to use in medical practice.


Assuntos
Gerenciamento Clínico , Dor de Orelha , Otite Média com Derrame , Otolaringologia/métodos , Manejo da Dor/métodos , Medição da Dor/métodos , Sociedades Médicas , Dor de Orelha/diagnóstico , Dor de Orelha/etiologia , Dor de Orelha/terapia , Humanos , Otite Média com Derrame/complicações , Otite Média com Derrame/diagnóstico , Otite Média com Derrame/terapia , Guias de Prática Clínica como Assunto
6.
Am J Emerg Med ; 34(1): 117.e1-3, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26078258

RESUMO

Luc abscess is an uncommon suppurative complication of otitis media. Unfamiliarity of this complication leads to delayed diagnosis and treatment. This abscess is usually benign. Infection in the middle ear spreads via anatomic preexisting pathways, and this process results with subperiosteal pus collection. Conservative treatment with drainage under empirical wide spectrum antibiotic is efficient. Here,we present a 9-year-old boy who had left facial swelling after a period of otalgia, diagnosed as Luc abscess without mastoiditis.


Assuntos
Abscesso/etiologia , Mastoidite/etiologia , Otite Média Supurativa/complicações , Abscesso/diagnóstico , Abscesso/terapia , Antibacterianos , Criança , Diagnóstico Diferencial , Drenagem , Dor de Orelha/diagnóstico , Dor de Orelha/etiologia , Dor de Orelha/terapia , Humanos , Masculino , Mastoidite/diagnóstico , Mastoidite/terapia , Otite Média Supurativa/diagnóstico , Otite Média Supurativa/terapia , Otoscopia , Tomografia Computadorizada por Raios X
7.
Niger J Med ; 24(2): 175-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26353430

RESUMO

BACKGROUND: This study reports two cases of undeclared and unusual foreign body (FB) impaction in the ears of Nigerian adult patients that were accidentally discovered and successfully managed. AIM: The report aims to create awareness, and encourage Otorhinolaryngologist to have proper otoscopy done for all patients with suspected ear FB and double check again following FBs removal. CONCLUSION It has recommended a need for an increased public enlightenment to raise awareness about the danger of cleaning the ears with cotton swab or other sharp materials.


Assuntos
Orelha/patologia , Corpos Estranhos , Perda Auditiva , Otoscopia/métodos , Dor de Orelha/etiologia , Dor de Orelha/terapia , Feminino , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico , Corpos Estranhos/fisiopatologia , Corpos Estranhos/terapia , Educação em Saúde , Perda Auditiva/diagnóstico , Perda Auditiva/etiologia , Testes Auditivos , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Perfuração da Membrana Timpânica/etiologia , Perfuração da Membrana Timpânica/terapia
8.
Ann Otol Rhinol Laryngol ; 124(12): 953-6, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26139645

RESUMO

INTRODUCTION: In cases of otalgia without any accompanying findings, some patients locate their otalgia below the attachment of the lobule, at the apex of the jugulodigastric region. PURPOSE: To present a series of these patients for whom nasal steroids or myringotomy usually ameliorated their pain. MATERIALS AND METHODS: Thirty-two patients with normal physical examinations, tympanograms, and age-appropriate audiograms spontaneously indicated otalgia at "the otalgia point." Inspection of the oropharynx and nasal airway, palpation of the neck and temporal mandibular joints, and nasopharyngoscopy/laryngoscopy ruled out referred causes of otalgia. Patients were offered either nasal steroid spray or trial myringotomy followed by tympanostomy tube. RESULTS: Otalgia improved in all 10 (100%) patients who selected nasal steroids. Otalgia resolved in 17 of 20 (85%) myringotomy participants. Three patients declined intervention. In all, symptoms improved in 27/29 treated patients (93%). CONCLUSION: This description of "the otalgia point" introduces a new otolaryngologic gesture in physical examination that can aid in the therapeutic management of some patients with otalgia and normal examinations. This is an uncontrolled case series that serves as a pilot study for further exploration of this gesture.


Assuntos
Dor de Orelha/diagnóstico , Dor de Orelha/terapia , Exame Físico/métodos , Adulto , Idoso , Endoscopia/métodos , Feminino , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Sprays Nasais , Membrana Timpânica/cirurgia
9.
Am J Otolaryngol ; 36(3): 451-5, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25655316

RESUMO

Recently, the author experienced a case of intractable right-sided otalgia in a 17-year-old male patient. The pain was intermittent and frequently radiated to the right forehead and periorbital region. He had received unsuccessful medical treatments for migraine headache. The otoendoscopic examination revealed a normal tympanic membrane. Nasal endoscopy showed only an intranasal mucosal contact point between the septal crest and the right inferior turbinate, without other signs of sinus inflammation. Topical application of an anesthetic and vasoconstrictive solution-soaked cotton pledget at the intranasal contact area made the patient experience a significant improvement of symptoms. After surgical removal of the mucosal contact point by conventional septoplasty and turbinoplasty, he experienced significant relief of symptoms and complete recovery. Here, the author report a case of intractable otalgia induced by nasal septal deviation with review of literatures, and suggestion for new disease entity of rhinogenic contact point otalgia induced by nasal septal deviation is carefully made.


Assuntos
Dor de Orelha/etiologia , Dor de Orelha/patologia , Septo Nasal/anormalidades , Septo Nasal/cirurgia , Adolescente , Dor de Orelha/terapia , Endoscopia , Humanos , Masculino
10.
BMJ Clin Evid ; 20152015 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-25599243

RESUMO

INTRODUCTION: Changes in air pressure during flying can cause ear-drum pain and perforation, vertigo, and hearing loss. It has been estimated that 10% of adults and 22% of children might have changes to the ear drum after a flight, although perforation is rare. Symptoms usually resolve spontaneously. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of interventions to prevent middle-ear pain during air travel? We searched: Medline, Embase, The Cochrane Library and other important databases up to July 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found three studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: nasal balloon inflation, nasal decongestants (topical), and oral pseudoephedrine.


Assuntos
Viagem Aérea , Dor de Orelha/terapia , Dor de Orelha/tratamento farmacológico , Dor de Orelha/prevenção & controle , Humanos , Descongestionantes Nasais/uso terapêutico , Pseudoefedrina/uso terapêutico
11.
Eur Arch Otorhinolaryngol ; 272(12): 3677-83, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25524643

RESUMO

Studies on endonasal dilatation of the Eustachian tube (EET) utilizing a balloon catheter have shown encouraging results over the last years. This retrospective analysis presents our outcomes with EET in children with chronic obstructive dysfunction of the Eustachian tube, as well as the role of tubomanometry (TMM, Estève) as a diagnostic tool in the pre- and postoperative assessment of the Eustachian tube (ET) dysfunction. The data of 33 children, having undergone EET between September 2010 and March 2014, were retrospectively evaluated. They were assessed using tubomanometry before and after the EET. The R-data as the rate of Eustachian tube function in tubomanometry (TMM) were pre- and postoperatively matched with the clinical outcomes. Moreover, the patients' complaints before and after the procedure were analyzed. We did not see any EET-related complications in children. Most patients noticed a relief of their complaints. In the same time, tubomanometry was not able to show improved tube function or favorable postoperative changes in the R-data. Ear-related symptoms (e.g. otorrhea, otalgia, hearing loss) have been improved. EET is a feasible method in adults as well as in children to treat chronic tube dysfunction. However, tubomanometry does not seem to be the adequate tool to evaluate the tube function and thus the success rate of EET in children with chronic dysfunction of the Eustachian tube.


Assuntos
Dilatação/métodos , Tuba Auditiva/fisiopatologia , Adolescente , Criança , Constrição Patológica/fisiopatologia , Constrição Patológica/terapia , Dilatação/instrumentação , Dor de Orelha/etiologia , Dor de Orelha/terapia , Estudos de Viabilidade , Feminino , Perda Auditiva/etiologia , Perda Auditiva/terapia , Humanos , Masculino , Manometria , Estudos Retrospectivos
12.
J Laryngol Otol ; 128(5): 394-9, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24819337

RESUMO

OBJECTIVE: To systematically summarise the peer-reviewed literature relating to the aetiology, clinical presentation, investigation and treatment of geniculate neuralgia. DATA SOURCES: Articles published in English between 1932 and 2012, identified using Medline, Embase and Cochrane databases. METHODS: The search terms 'geniculate neuralgia', 'nervus intermedius neuralgia', 'facial pain', 'otalgia' and 'neuralgia' were used to identify relevant papers. RESULTS: Fewer than 150 reported cases were published in English between 1932 and 2012. The aetiology of the condition remains unknown, and clinical presentation varies. Non-neuralgic causes of otalgia should always be excluded by a thorough clinical examination, audiological assessment and radiological investigations before making a diagnosis of geniculate neuralgia. Conservative medical treatment is always the first-line therapy. Surgical treatment should be offered if medical treatment fails. The two commonest surgical options are transection of the nervus intermedius, and microvascular decompression of the nerve at the nerve root entry zone of the brainstem. However, extracranial intratemporal division of the cutaneous branches of the facial nerve may offer a safer and similarly effective treatment. CONCLUSION: The response to medical treatment for this condition varies between individuals. The long-term outcomes of surgery remain unknown because of limited data.


Assuntos
Dor de Orelha , Dor Facial , Herpes Zoster da Orelha Externa , Neuralgia , Dor de Orelha/diagnóstico , Dor de Orelha/etiologia , Dor de Orelha/terapia , Dor Facial/diagnóstico , Dor Facial/etiologia , Dor Facial/terapia , Herpes Zoster da Orelha Externa/diagnóstico , Herpes Zoster da Orelha Externa/etiologia , Herpes Zoster da Orelha Externa/terapia , Humanos , Neuralgia/diagnóstico , Neuralgia/etiologia , Neuralgia/terapia
13.
J Fam Pract ; 62(9): 503-5, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24080560
14.
Am J Otolaryngol ; 34(6): 718-9, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23948794

RESUMO

Idiopathic causes of retroauricular pain are rarely seen in clinical practice. We present a 9-year-old child who suffered from atypical retroauricular pain resistant to conventional treatment. After excluding any other cause of retroauricular pain, a nerve block was performed with a 0.3 ml lidocaine 1% injection into the trigger point. We believe that this case report is important because in the literature there are no similar cases described in children.


Assuntos
Dor de Orelha/terapia , Bloqueio Nervoso , Aminas/uso terapêutico , Analgésicos/uso terapêutico , Anestésicos Locais/administração & dosagem , Carbamazepina/uso terapêutico , Criança , Ácidos Cicloexanocarboxílicos/uso terapêutico , Gabapentina , Humanos , Injeções , Lidocaína/administração & dosagem , Masculino , Pontos-Gatilho , Ácido gama-Aminobutírico/uso terapêutico
15.
Emerg Med Clin North Am ; 31(2): 413-42, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23601480

RESUMO

Earache, a common emergency department presentation, may be caused by a variety of conditions, some distant from the ear. This article discusses the diagnosis and treatment of acute otitis media, otitis media with effusion, otitis externa, otitis media with ruptured tympanic membrane or tympanostomy tubes, malignant otitis externa, mastoiditis and petrositis, traumatic ruptured tympanic membrane, cerumen impactions, and foreign bodies in the ears.


Assuntos
Dor de Orelha/diagnóstico , Antibacterianos/uso terapêutico , Orelha Interna , Dor de Orelha/etiologia , Dor de Orelha/terapia , Emergências , Serviço Hospitalar de Emergência , Corpos Estranhos/diagnóstico , Corpos Estranhos/terapia , Humanos , Otite Média/diagnóstico , Otite Média/tratamento farmacológico , Otite Média/terapia
16.
World Neurosurg ; 80(6): e353-7, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23178920

RESUMO

OBJECTIVE: Geniculate neuralgia is an uncommon pain syndrome that can be severe and disabling and is difficult to diagnose. METHODS: The literature was reviewed for geniculate neuralgia, including anatomy, presentation, and treatment. A case illustration was presented that demonstrates the novel brainstem functional imaging findings for geniculate neuralgia. A 39-year-old man presented with a history of left "deep" ear pain within his ear canal. He noted occasional pain on the left side of his face around the ear. He had been treated with neuropathic pain medications without relief. His wife described suicidal ideations discussed by her husband because of the intense pain. RESULTS: The patient's neurologic examination was normal, and otolaryngologic consultation revealed no underlying structural disorder. Anatomic imaging revealed a tortuous vertebral artery-posterior inferior cerebellar artery complex with the posterior inferior cerebellar artery loop impinging on the root entry zone of the nervus intermedius-vestibulocochlear nerve complex and just inferior to the root entry zone of the facial nerve and a small anterior inferior cerebellar artery loop interposed between the cranial nerve VII-VIII complex and the hypoglossal and glossopharyngeal nerves. A left-sided retromastoid craniotomy was performed, and the nervus intermedius was transected. An arterial loop in contact with the lower cranial nerves at the level of the brainstem was mobilized with a polytetrafluoroethylene implant. CONCLUSIONS: The patient indicated complete relief of his preoperative pain after surgery. He has remained pain-free with intact hearing and balance.


Assuntos
Herpes Zoster da Orelha Externa/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adulto , Cerebelo/irrigação sanguínea , Cerebelo/diagnóstico por imagem , Nervos Cranianos/patologia , Nervos Cranianos/cirurgia , Craniotomia , Dor de Orelha/etiologia , Dor de Orelha/terapia , Herpes Zoster da Orelha Externa/diagnóstico por imagem , Herpes Zoster da Orelha Externa/patologia , Humanos , Processamento de Imagem Assistida por Computador , Imagem por Ressonância Magnética , Masculino , Microcirurgia , Neuralgia/etiologia , Neuralgia/terapia , Radiografia , Resultado do Tratamento
17.
Acta méd. (Porto Alegre) ; 33(1): [6], 21 dez. 2012.
Artigo em Português | LILACS | ID: biblio-879483

RESUMO

O presente artigo de revisão tem por objetivo orientar o leitor quanto ao diagnóstico diferencial de otalgia e seus respectivos tratamentos. O trabalho se mostra importante devido a frequente queixa do sintoma nas consultas de emergências.


This review article aims to guide the reader to the differential diagnosis of earache and its treatment. The work is relevant due to the frequent complaint of the symptom in clinical emergencies.


Assuntos
Dor de Orelha/diagnóstico , Dor de Orelha/terapia , Anamnese
18.
Agri ; 24(2): 69-76, 2012.
Artigo em Turco | MEDLINE | ID: mdl-22865491

RESUMO

OBJECTIVES: This study was conducted to determine women's about attitudes child's teeth, abdomen and ear ache. METHODS: Those who had lived in Antalya that 6 number primary health care center between March-May 2004 were enrolled in the study. As data collecting tools. A questionnaire prepared by the authors. This study was determined that 29.2 % of the mothers carried out mixture who had prepared at home to child's abdomen and foot base; 30.3 % were to put breast milk childs' ear; 38.9 % were placed aspirin, salt and salts of lemon to childs' teeth ache. RESULTS: The majority of the women make a wrong practices child that teeth, abdomen and ear ache. This traditional practice effecting factors were the women's educational status and age. CONCLUSION: The results of the study that education about child care, common health problems and incorrect applications shoud be given to women by nurse.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Cuidado do Lactente/estatística & dados numéricos , Mães , Adulto , Serviços de Saúde da Criança , Diarreia Infantil/terapia , Dor de Orelha/terapia , Feminino , Humanos , Lactente , Centros de Saúde Materno-Infantil , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Inquéritos e Questionários , Odontalgia/terapia , Turquia/epidemiologia , Serviços de Saúde da Mulher
20.
Cardiol J ; 17(6): 623-4, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-21154267

RESUMO

Patients presenting with acute coronary syndromes are classically described as having chest pressure with radiation to the left arm. However, pain can be referred to multiple sites including the face, the neck, the abdomen and the contra-lateral arm. We present a case of sudden bilateral ear pain as the sole presentation of acute coronary syndrome in an elderly man. The importance of recognizing these atypical presentations is vital, as outcomes may be worsened as appropriate therapy may be delayed or misdirected.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Diagnóstico Tardio , Dor de Orelha/etiologia , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/terapia , Idoso de 80 Anos ou mais , Dor de Orelha/terapia , Evolução Fatal , Humanos , Masculino , Cuidados Paliativos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA