Earache discharge and ear ache


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This presentation discusses ear discharge, ear ache and their management.

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Earache discharge and ear ache

  1. 1. Ear ache & Ear discharge Dr T BalasubramanianAutor: 18.04.12
  2. 2. Anatomy External ear Middle ear Internal earAutor: 18.04.12
  3. 3. External ear Pinna External auditory canal Lateral surface of ear drumAutor: 18.04.12
  4. 4. PINNA - ANATOMYAutor: 18.04.12
  5. 5. PINNA INNERVATIONAutor: 18.04.12
  6. 6. Pinna InnervationAutor: 18.04.12
  7. 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 mmAutor: 18.04.12
  8. 8. External canal - InnervationAutor: 18.04.12
  9. 9. Innervation of middle ear Sensory supply to middle ear is via glossopharyngeal component of tympanic plexus Jacobsons branch of glossopharyngeal nerve is the precise supply Medial portion of ear drum is supplied via chorda tymopaniAutor: 18.04.12
  10. 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 Menieres disease considerable enlargment of membranous labyrinth can cause stretching of these nerves leading on to a sense of fullness in the earAutor: 18.04.12
  11. 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 supplyAutor: 18.04.12
  12. 12. Primary otalgia External ear causes Middle ear causes Inner ear causesAutor: 18.04.12
  13. 13. External ear causes of otalgia Also known as otitis externa This is a very painful condition Patient usually lose sleep Tragal sign positiveAutor: 18.04.12
  14. 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 externaAutor: 18.04.12
  15. 15. Otitis externa – Predisposing factors Absence of cerumen Removal of cerumen by ear buds Frequent exposure to waterAutor: 18.04.12
  16. 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 colonizeAutor: 18.04.12
  17. 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 colonizationAutor: 18.04.12
  18. 18. Furuncle Tragal sign positive Affects cartilagenous portion of external canal because of hair follicles Staph aureus is the common infecting organismAutor: 18.04.12
  19. 19. Acute diffuse otitis externa Also known as swimmers 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. 20. Chronic otitis externa Unrelenting pruritus Mild pain External canal skin appears dry Fungal infections commonly cause this problem Dermatological condition like eczemaAutor: 18.04.12
  21. 21. Managment Treatment of infection Removal of epithelial debris IG paint dipped wick to reduce oedema Anti-inflammatory drugsAutor: 18.04.12
  22. 22. OtomycosisAutor: 18.04.12
  23. 23. Malignant otitis externa Misnormer Common in elderly diabetics Pseudomonas is the causative organism External canal granulation Facial paralysis Erosion of temporal bone Nocturnal otalgiaAutor: 18.04.12
  24. 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 symptomsAutor: 18.04.12
  25. 25. Malignant otitis externa (Images)Autor: 18.04.12
  26. 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 commonAutor: 18.04.12
  27. 27. Management of Bullous myringitis Decompression of bullae – if otalgia is intense Topical / oral antibiotics Steroids AnalgesicsAutor: 18.04.12
  28. 28. Middle ear causes of otalgia Acute otitis media (AOM) Eustachean tube dysfunction Otitis barotraumaAutor: 18.04.12
  29. 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 perforatesAutor: 18.04.12
  30. 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 infectionAutor: 18.04.12
  31. 31. Ramsay Hunt syndrome (Contd)Autor: 18.04.12
  32. 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 cellulitisAutor: 18.04.12
  33. 33. Neoplasms Primary neoplasms of pinna / external canal Neoplasms involving skull base Malignancy involving ceruminous glandsAutor: 18.04.12
  34. 34. Miscellaneous causes Trauma Hematoma Seroma Frost bite Burns / Thermal injuriesAutor: 18.04.12
  35. 35. Referred otalgia TM joint disorders Eagle syndrome Gerd Neuralgias Neoplasms of oropharynx/oral cavity Cervical arthritisAutor: 18.04.12
  36. 36. Ear discharge Wax (Normal) Pus Mucous Blood CSF SalivaAutor: 18.04.12
  37. 37. Purulent discharge Acute suppurative otitis media Chronic suppurative otitis media Rupturing furuncle of external auditory canalAutor: 18.04.12
  38. 38. Sinister ear discharge Scanty Purulent Discharge associated with excessive otalgia Discharge associated with giddiness Discharge associated with head ache Discharge associated with tinnitusAutor: 18.04.12
  39. 39. OtoscopyAutor: 18.04.12
  40. 40. Autor: 18.04.12
  41. 41. Complications of discharging ear Deafness Extracranial Intra temporal complication Extra cranial complication Intra cranial complication Facial nerve paralysis Lateral sinus thrombosisAutor: 18.04.12
  42. 42. Thank youAutor: 18.04.12
  43. 43. Management Aural toilet Culture Topical antibiotics – CSOM Systemic antibiotics – ASOM / AOM Resistant cases / unsafe - surgeryAutor: 18.04.12