Earache

EaracheAny pain in the ear is an earache. It may correspond to an ear infection, or being the dominant location or not of pain following a neighborly affection, sometimes serious such oro-pharyngolaryngeal cancer. Obviously diagnoses mentioned are very different depending on the age and the field.

CAUSE EAR:

This is most often inflammatory diseases of the external ear or middle ear.

Diagnosis is based on otoscopy after inspection of the pavilion and the proximal part of the external auditory meatus. The use of the microscope or at least a magnifying system greatly facilitates the review and ensure quality.The frequent existence of cérumineux or epidermal debris and even the presence of a flow, requires the provision of an aspiration to visualize all the walls and especially the eardrum. Thus, earache can immediately be reported to the following causes.

Injury of the outer ear:

Otitis externa:

More often inflammatory or infectious, it is the classic otitis externa (which is not an ear infection, but a skin disease), bacterial or fungal.

It is favored by any previous injury (eczema), by bathing in pool and between readily under the conditions called vacation. Sometimes found the notion of trauma, even more so in the presence of pruritic eczema with lesions scrapings using all kinds of instruments (paper clips, hair pins, etc.).

This is often a very painful infection, reasons if need prescription painkillers morphine major type. We close the boil duct.

A bacteriological sample allows in principle to identify the causative organism (often staphylococcus). We must also seek a fungus that would be aggravated by the prescription of local and systemic antibiotics.

The existence of filaments, the tenacity of the infection, his exasperation with antibiotic treatment, have to think systematically about otitis externa.

Malignant otitis externa:

Otitis externa, called malignant, is a serious, very serious even in the absence of timely and appropriate treatment.Mortality is close indeed 30% in some statistics.

It is seen in diabetic or immunocompromised and succeeds most often at minimal trauma. It corresponds almost exclusively to infection by Pseudomonas aeruginosa Proteus much more rarely.

It is characterized by extensive development, necrotizing with impaired general condition, cartilage damage and bone, gradually leading to destruction of the rock and skull base with paralysis, particularly often revealing facial paralysis . In the absence of treatment or therapeutic effectiveness evolution is towards death often by brain abscess, thrombophlebitis of the cavernous sinus, etc.

The scanner essentially allows you to track

the evolution of lesions and appreciate gradually treatment efficacy. MRI is required in case of neurological extension.

Treatment is a perfect equilibration of diabetes and especially massive and prolonged antibiotic therapy (two months) taking into account the clinical and radiological evolution and antibiotic susceptibility data.

Hyperbaric oxygen therapy has been proposed.

Surgery has little place here and is only a supplement to medical treatment. It is also discussed.

Chondrites:

Chondrites reach the conduit and the pavilion.

They succeed more often to trauma with hematoma (sometimes postsurgical).

If they are spontaneous, they should be investigated, relapsing polychondritis (see Chapter Red Ear). The natural course is to necrosis of cartilage deformation with final flag.

Zona VII:

Shingles VII is marked by pain “in the pipe” and the discovery of vesicles in the concha (Ramsay Hunt zone).

Facial paralysis is often indicative and is attached to his cause by our reviews of the pavilion and the canal.

Treatment is based on the Zélitrex® 500 mg, 2 tablets / day for 1 week.

Cyst and fistula:

Cysts and fistulas (first slot) are rarely painful outside superinfection.

Malignant neoplasm of leads:

Malignant tumors of the duct are rare but serious. Adenoid cystic carcinoma (cylindroma) is probably the most common form.

It is often very painful.

The tumor is shown by the presence of tissue formation in the conduit, of course requiring biopsy and histological examination.

The treatment is surgical.

Lesion of the middle ear:

Acute otitis media:

The pathology of the middle ear, painful, is essentially represented by the so acute otitis media and occurs particularly in children.

Diagnosis is based on otoscopy allows to specify the stadium.

Antibiotic treatment is usually probabilistic and takes into account the most commonly encountered bacteria(Haemophilus or pneumococcus, depending on age). Paracentesis mainly has an analgesic interest.

Myringitis phlyctenular:

The myringitis phlyctenular is very painful, corresponding to small blisters on the eardrum, it is seen in the flu.

Tubal obstruction easy:

Simple tubal blockage can be downright painful in its acute form (aircraft descent barotrauma). The chronic form is characterized by discomfort with hearing loss.

Tympanometry provides the diagnosis.

Nonsteroidal anti-inflammatory drugs can be helpful.

Tuberculous otitis:

The tuberculous otitis is exceptional.

See treatment of tuberculosis or prolonged fever.

Chronic otitis:

Chronic otitis, whatever its form, is not painful unless acute infection.

CAUSE EXTRA EAR:

Earache extra-atrial case justify the utmost attention if earache eardrum to normal as soon as age, risk context (alcoolotabagique) may fear the development of cancer. The earache is indeed one of the best organic signs of oropharyngeal cancers, hypopharyngeal or laryngeal.

If the examination of the oral cavity, oropharynx (tonsillar fossa) is possible by the general practitioner, it is not the same for the hypopharynx and larynx which compliance can be done by laryngoscopy indirect mirror by endoscopy or by endoscopy under general anesthesia.

This is a serious error not to claim these examinations by a specialist as soon as the ear pain does not find local explanation and that the subject can be considered at risk.

Angina:

For memory we recall the pain in the ear of angina to emphasize the possible progression to abscess of the tonsil (ie angina who unilatéralise and soon accompanied by lockjaw). The existence of an edema of the uvula, the arch of the anterior pillar of the tonsil, the buckling inward thereof, are signs announcing the collection and justifying surgical evacuation.

The scanner provides considerable help to affirm the collection.

Antibiotic treatment may comprise first line of amoxicillin (2 to 3 g / day for 5 days).

Oral Cause:

Oral causes of ear pain are mainly represented, apart from the “acute abscess wisdom tooth” by malfunctions of the temporomandibular joint.

But this is where a diagnosis of exclusion after considering all other causes. The existence of crunches, the presence of a jump (or subluxation), a dental disorder hinged make plausible diagnosis.

MRI of the temporomandibular joint provides diagnostic objective arguments.

Neuralgia:

Neurological manifestations, glossopharyngeal neuralgia, trigeminal neuralgia (auriculotemporale branch) features are in order by their sudden onset, evolution by short attacks and their intensity.

The geniculate ganglion was mentioned in paragraph Zona.

Analgesic treatment appealed primarily to carbamazepine.

CONCLUSION:

The problem before an earache is not to miss a serious condition, and know demand a specialized examination when the examination of the ear does not state the cause. The negativity of the review conducted / eardrum must in no case stop the search as long as the age and the field can be considered a cancer diagnosis. Recall that the nasopharyngeal cancer (nasopharynx) may be a tubal blockage and that occurs outside of any exogenous risk factor (admittedly a relatively targeted population: Mediterranean, southern China). This is an argument for never neglect an earache, the cause is not obvious.

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Editor-in-chief of the Medical Actu website; general practitioner graduated from the Faculty of Medicine of Algiers in 2005 currently practicing as a liberal.

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