THE PAINFUL

EAR
 CAUSES

LOCAL REFERRED

Traumatic V, VII, XI, X, C2,3

Inflammatory Nose
Nasopharynx
AURICLE Teeth
EAC Oropharynx
TYMPANIC MEMBRANE Larynx & Hypopharynx
cervical 2,3
LOCAL – AURICLE –
TRAUMATIC
HEMATOMA AURIS
Painful
Reddish
Cystic or soft
 WHAT IS IT?
 WHAT CAUSES
 CP
 COMPLICATIONS
 TTT
LOCAL – AURICLE –
TRAUMATIC –
LACERATION

 WHAT CAUSE?
 CP

 COMPLICATIONS

 TTT
LOCAL – AURICLE -
INFLAMMATORY
PERICHONDRITIS
SWOLLEN
REDDISH
 WHAT IS IT? HOT
 WHAT CAUSES LOBULE ??
 CP

 COMPLICATIONS

 TTT
Erysielas vs Perichondritis
LOCAL - EAC
INFLAMMATORY
OTITIS EXTERNA
BACTERIAL
Diffuse OE
Localized VIRAL
MOE Bullous Myringitis
Herpes Zoster Oticus FUNGAL
Otomycosis
LOCAL - EAC
INFLAMMATORY
DIFFUSE OE
WHAT IS IT?

WHAT CAUSES

CP

TTT
LOCAL - EAC
INFLAMMATORY (Bacterial)
FURUNCULOSIS
WHAT IS IT?

WHAT CAUSES

CP

TTT
LOCAL - EAC
INFLAMMATORY (Bacterial)
NECROTIZING OE (MALIGNANT OE).

 WHAT IS IT?
 ORGANISM
invasive, and potentially fatal,
bacterial infection of the skin lining of
 INCIDENCE
the external canal which extends
 SYMPTOMS
beyond it to the base of the skull.
 SIGNS
LOCAL - EAC
INFLAMMATORY (Bacterial)
NECROTIZING OE (MALIGNANT OE).
Severe pain
 WHAT IS IT? 1) Speculum examination
Granulation tissues
 ORGANISM Otorrhoea . scanty, sanguineous and
 INCIDENCE purulent.

 SYMPTOMS 2) External examination

Tenderness
 SIGNS Pre-auricular and post-auricular LA.
 INVESTIGATIONS
 COMPLICATIONS
 TREATMENT
LOCAL - EAC
INFLAMMATORY (Bacterial)
NECROTIZING OE (MALIGNANT OE).

Osteomyelitis of temporal bone

 WHAT IS IT? and skull base . Cranial nerves
Palsy VII, IX , X & X!
 ORGANISM
 INCIDENCE
 SYMPTOMS
 SIGNS Control of diabetes.
 INVESTIGATIONS Massive antibiotic therapy e.g. quinolones
 COMPLICATIONS or 3rd generation cephalosporins  should
be continued till complete cure ( usually
 TREATMENT several weeks ).

Analgesics.
LOCAL - EAC
INFLAMMATORY (Viral)
BULLOUS MYRINGITIS

 WHAT IS IT?

 WHAT CAUSES

 CP

 TTT
LOCAL - EAC
INFLAMMATORY (Viral)
Herpes Zoster Oticus

1- Severe earache.
2- Sero-sanguinous otorrhoea
3- No fever or hearing loss.
 WHAT IS IT?

 WHAT CAUSES
 CP
 COMPLICATIONS
 TTT
RAMSAY HUNT SYNDROME

Herpes zoster oticus may be associated with ipsilateral lower motor neuron facial
nerve palsy  due to affection of the geniculate ganglion.

Sensori-neural hearing loss & vertigo  due to affection of the cochleo-vestibular

nerve.
LOCAL - EAC
INFLAMMATORY (Fungal)
OTOMYCOSIS

 WHAT IS IT?
ITCHING
 WHAT CAUSES HL
 ORGANISM
 PP FACTOR

 CP

 TTT
LOCAL – TYMPANIC MEMBRANE - TRAUMATIC
RUPTURE OF TYMPANIC
MEMBRANE

 WHAT CAUSES?
• Indirect trauma
• Direct trauma
LOCAL – TYMPANIC MEMBRANE - TRAUMATIC
RUPTURE OF TYMPANIC
MEMBRANE

 WHAT CAUSES? History

Earache
• Direct trauma Bloody otorrhea
• Indirect trauma Air
HL , Tinnitus

 CP
 Prognosis Central
 TTT In Pars Tensa
Irregular
 Conservative Hyperaemic sharp edges
 ?? Surgical Blood clots
LOCAL – TYMPANIC MEMBRANE - TRAUMATIC
RUPTURE OF TYMPANIC
MEMBRANE

 WHAT CAUSES?
PROPHYLACTIC ANTIBIOTICS
• Direct trauma
AVOID
• Indirect trauma • FORCIBLE BLOWING
• WETTING OF THE EAR
 CP
 Prognosis
 TTT
 Conservative
MYRINGOPLASTY ?
 ?? Surgical
LOCAL – Middle Ear
INFLAMMATORY
ACUTE OTITIS MEDIA
Acute inflammation of the muco-periosteal
lining of the middle ear cleft
 WHAT IS IT?

 ORGANISM

 ROUTES
 PATHOLOGY & CP
HL&T
NO EARACHE

1. STAGE OF TUBAL
CATARRH HL&T
EARACHE

2. STAGE OF
CATARRHAL OM HL&T
THROBBING PAIN

3. STAGE OF SOM
o Before perforation HL&T
NO PAIN
o After perforation OTORRHEA
 BEFORE PERFORATION
 MEDICAL
 SURGICAL

 AFTER PERFORATION
 MEDICAL
 SURGICAL
 LOCAL – COMPLICATED OM
MASTOIDITIS

WHAT IS IT ?

PATHOLOGY

Pus bursts
osteitis of erodes the through the
the bony walls external surface periosteum
and skin
 LOCAL – COMPLICATED OM
MASTOIDITIS
WHAT IS IT ? EARACHE
OTORRHEA+++
PATHOLOGY HL

SYMPTOMS
SIGNS
 LOCAL – COMPLICATED OM
MASTOIDITIS

WHAT IS IT ?

PATHOLOGY

SYMPTOMS
SIGNS
INVESTIGATIONS
TTT
• MEDICAL
• SURGICAL
LOCAL – COMPLICATED OM
MASTOIDITIS
LOCAL – COMPLICATED OM
PETROSITIS
REFERRED
OTALGIA
Auriculo-temporal Nerve v2 Upper two thirds

x
Great auricular nerve c2,3 Lower one third

Lesser occipital nerve – Upper part

Great auricular nerve - lower part

Posterior
x v Anterior
REFERRED
OTALGIA

NOSE
REFERRED
OTALGIA
REFERRED
OTALGIA
REFERRED
OTALGIA
REFERRED
OTALGIA