External Otitis
Signs and symptoms of OE include bilateral itching, and pain that worsens with manipulation of this part of the ear.
Pinna
Peak prevalence of AOM is in this age range - who are more susceptible due to a shorter & more horizontal Eustachian tube.
6-15 months (50-85% will have it by 3 years old)
Generally: <6 years old
OME is a common condition in this age range
6 months - 4 years old
Generally: children
This is most common in elderly patients and presents with "stuffed up" ears and potential pain and hearing loss
Impacted Cerumen
SO is caused by referred pain and is mainly experienced by what portion of the population?
Older patients
This variation is also called "swimmer's ear" and is characterized by pain, itching, fullness, hearing loss. Erythema of TM with normal mobility. Rapid onset; unilateral
Diffuse Acute OE
98% bacterial (Pseudomonas, staph)
AOM is usually secondary to this type of infection
URTI (i.e. viral, S. pneumonia, haemophilus influenza)
OME is the most common cause of what condition in children?
Hearing loss
*presents as sensation of crackling or decreased hearing
This is common with children aged 0-4 with pain mainly localized in the external ear canal
Foreign Body
Otalgia is experienced by patients with this type of disorder, characterized by pain that is worse with chewing. 50% is due to tooth pain from CN V (trigeminal nerve). Unilateral & pain worse in morning. Jaw click.
TMJ disorders
This variation of OE tends to be more bilateral and longer-lasting (>1 week) with predisposing conditions including allergic reaction, psoriasis, and chronic infection. May lead to cholesteatoma.
Chronic
The tympanic membrane will typically have this appearance with AOM
Cloudy/opaque or red and bulging with reduced mobility
The tympanic membrane will have this type of appearance with OME (colour, opacity, retraction)
Gray/pink; translucent; fluid-filled/bubbles; retracted position
This may produce an acute serous otitis caused by change in pressure -- relief with chewing etc.
Barotrauma
This type of inflammation in the maxillary/ethmoid due to the 5th cranial nerve may cause SO
Sinusitis
This variation of OE is a medical emergency - it may damage the bones of the ear and presents with purulent otorrhea and facial nerve palsy.
Necrotizing (Malignant) OE
With tympanic membrane perforation, one can expect to find these two consequences
When conducting a Rinne hearing test, what might be a finding in a patient with OME?
Conductive hearing loss
Bone conduction > air conduction
Trauma of the ear causes perforation of the tympanic membrane visible on physical exam; we can expect to see healing within this time frame
4-6 weeks
This type of inflammation may cause secondary otalgia and often has a viral cause i.e. herpes, mumps, Epstein-barr
Parotitis (swelling of parotid [salivary] glands)
Upon examination of the ear, what can we expect to see regarding the ear canal?
Inflamed, swollen ear canal with discharge. TM normal or not visible.
*Enlarged pre/post auricular lymph nodes.
Suppurative complications are uncommon but may occur after TM perforation and lead to this type of post-auricular swelling
Mastoiditis
OME tends to occur after what type of infection (esp. in adults)
URTI or AOM
Upon physical examination, this condition commonly appears as a pearly white lesion/cyst on the pars flaccida or behind the TM; TM may be recently perforated. It is an immediate referral as it is life threatening. It is a result of chronic negative middle ear pressure. Symptoms include hearing loss and fullness. Sequelae of chronic otitis media.
Cholesteatoma
Pain in the cervical spine (CN2&3) or in carious teeth (CN5) may cause pain in this part of the ear
External ear
Which population is this condition most prominent in? What are some predisposing factors?
Adults; diabetes, swimmers, ear pickers
Does this condition present with a fever?
Yes
In performing a pneumatic otoscope exam, what would you be likely to find?
Depending on the shape of the cone of light, TM will be in a bulged or retracted position. TM may be immobile.
This condition presents with a history of ear pain, enlarged cervical lymph nodes, AOM. Throat culture may be indicated (as it's associated with strep throat) or Monospot in adolescents (as it's associated with mononucleosis)
Cervical lymphadenitis
What 4 cranial nerves may be associated with referred ear pain?
V, VII, IX & X
V = trigeminal - auricle, tragus, anterior TM
VII, IX, X = facial, glossopharyngeal, vagus - posterior TM & external auditory canal