Earache discharge and ear ache
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This document discusses the anatomy and causes of ear ache and ear discharge. It describes the external, middle and inner ear structures and their innervation. Common causes of ear ache include otitis externa, acute otitis media, Ramsay Hunt syndrome, and referred pain from other structures like the TM joint. Ear discharge can be normal cerumen or abnormal purulent, bloody, or clear fluid indicating various ear conditions. Complications from untreated ear discharge include deafness, bone erosion, and brain infections.
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Earache discharge and ear ache
- 1. Ear ache & Ear discharge Dr T Balasubramanian Autor: 18.04.12
- 2. Anatomy External ear Middle ear Internal ear Autor: 18.04.12
- 3. External ear Pinna External auditory canal Lateral surface of ear drum Autor: 18.04.12
- 4. PINNA - ANATOMY Autor: 18.04.12
- 7. External auditory canal Outer 1/3 cartilagenous Inner 2/3 bony About an inch long Postero-superior wall – 25 mm Antero-inferior wall – 31 mm Autor: 18.04.12
- 8. External canal - Innervation Autor: 18.04.12
- 9. Innervation of middle ear Sensory supply to middle ear is via glossopharyngeal component of tympanic plexus Jacobson's branch of glossopharyngeal nerve is the precise supply Medial portion of ear drum is supplied via chorda tymopani Autor: 18.04.12
- 10. Inner ear innervation Inner ear is supplied by vestibulocochlear nerve This nerve doesnt have pain fibers, significant pathologies of inner ear can develop without painful symptoms Vestibulocochlear nerves are sensitive to stretch. In Meniere's disease considerable enlargment of membranous labyrinth can cause stretching of these nerves leading on to a sense of fullness in the ear Autor: 18.04.12
- 11. Otalgia Is defined as pain localised to the ear It can either be primary / referred Primary otalgia is caused by pathology localized to the ear Referred otalgia is caused by disorders not related to the ear but to its nerve supply Autor: 18.04.12
- 12. Primary otalgia External ear causes Middle ear causes Inner ear causes Autor: 18.04.12
- 13. External ear causes of otalgia Also known as otitis externa This is a very painful condition Patient usually lose sleep Tragal sign positive Autor: 18.04.12
- 14. Otitis externa classification Acute diffuse otitis externa (commonly bacterial) Acute localised otitis externa (Furuncle) Chronic otitis externa Eczematous otitis externa Fungal otitis externa Malignant otitis externa Autor: 18.04.12
- 15. Otitis externa – Predisposing factors Absence of cerumen Removal of cerumen by ear buds Frequent exposure to water Autor: 18.04.12
- 16. Anti infective role of cerumen Protects external canal skin from moisture It has antibacterial properties Lowers the pH of external canal making the environment difficult for pathogens to colonize Autor: 18.04.12
- 17. Role of water in otitis externa Macrerates skin lining of external canal Increases the pH of external canal making the environment favorable for bacterial colonization Autor: 18.04.12
- 18. Furuncle Tragal sign positive Affects cartilagenous portion of external canal because of hair follicles Staph aureus is the common infecting organism Autor: 18.04.12
- 19. Acute diffuse otitis externa Also known as swimmer's ear Skin of external canal is involved in a diffuse manner Water exposure is the common cause External canal is itchy External canal diameter is reduced due to oedema Conductive deafness (rare) Autor: 18.04.12
- 20. Chronic otitis externa Unrelenting pruritus Mild pain External canal skin appears dry Fungal infections commonly cause this problem Dermatological condition like eczema Autor: 18.04.12
- 21. Managment Treatment of infection Removal of epithelial debris IG paint dipped wick to reduce oedema Anti-inflammatory drugs Autor: 18.04.12
- 23. Malignant otitis externa Misnormer Common in elderly diabetics Pseudomonas is the causative organism External canal granulation Facial paralysis Erosion of temporal bone Nocturnal otalgia Autor: 18.04.12
- 24. Malignant otitis externa (contd) History of trivial trauma (ear bud use) + Granulation begins at the bony cartilagenous junction Discharge from external canal scanty No fever / constitutional symptoms Autor: 18.04.12
- 25. Malignant otitis externa (Images) Autor: 18.04.12
- 26. Bullous myringitis Also known as bullous otitis externa Acute infection of ear drum and external auditory canal There is intra epithelial fluid collection Bullae may be present over the lateral surface of ear drum Bullae may also be present in the external auditory canal Otalgia with serous / bloody ear discharge common Autor: 18.04.12
- 27. Management of Bullous myringitis Decompression of bullae – if otalgia is intense Topical / oral antibiotics Steroids Analgesics Autor: 18.04.12
- 28. Middle ear causes of otalgia Acute otitis media (AOM) Eustachean tube dysfunction Otitis barotrauma Autor: 18.04.12
- 29. AOM Ear drum could be seen bulging Accumulation of fluid in the middle ear cavity Preceded by URI Common in children Pain subsides when drum perforates Autor: 18.04.12
- 30. Ramsay Hunt Syndrome Herpes zoster oticus Otalgia + Facial palsy (LMN) Rash over ipsilateral pinna / external canal Otalgia is due to irritation of 7th nerve due to Herpes virus infection Autor: 18.04.12
- 31. Ramsay Hunt syndrome (Contd) Autor: 18.04.12
- 32. Relapsing polychondritis Involves cartilage of pinna and external auditory canal Intense otalgia is seen End stage is fibrosis Sparing of lobule differentiates it from cellulitis Autor: 18.04.12
- 33. Neoplasms Primary neoplasms of pinna / external canal Neoplasms involving skull base Malignancy involving ceruminous glands Autor: 18.04.12
- 34. Miscellaneous causes Trauma Hematoma Seroma Frost bite Burns / Thermal injuries Autor: 18.04.12
- 35. Referred otalgia TM joint disorders Eagle syndrome Gerd Neuralgias Neoplasms of oropharynx/oral cavity Cervical arthritis Autor: 18.04.12
- 36. Ear discharge Wax (Normal) Pus Mucous Blood CSF Saliva Autor: 18.04.12
- 37. Purulent discharge Acute suppurative otitis media Chronic suppurative otitis media Rupturing furuncle of external auditory canal Autor: 18.04.12
- 38. Sinister ear discharge Scanty Purulent Discharge associated with excessive otalgia Discharge associated with giddiness Discharge associated with head ache Discharge associated with tinnitus Autor: 18.04.12
- 40. Autor: 18.04.12
- 41. Complications of discharging ear Deafness Extracranial Intra temporal complication Extra cranial complication Intra cranial complication Facial nerve paralysis Lateral sinus thrombosis Autor: 18.04.12
- 43. Management Aural toilet Culture Topical antibiotics – CSOM Systemic antibiotics – ASOM / AOM Resistant cases / unsafe - surgery Autor: 18.04.12