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1. Ear ache
15.3.2021

2. ANATOMY OF EAR

3. PINNA - ANATOMY

4. PINNA INNERVATION

5. External auditory canal
Outer 1/3 cartilagenous
Inner 2/3 bony
24-26 mm

6. Pinna Innervation

7. External canal - Innervation

8. 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

9. 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

10. Otalgia
Is defined as pain localised to ear.
• 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

11. Primary otalgia
External ear causes Middle ear causes Inner ear causes

12. External ear causes of otalgia
• Also known as otitis externa(OE)
• very painful condition
• Patient usually lose sleep
• Tragal sign positive

13. Otitis externa
Classifications
Acute diffuse otitis externa (commonly bacterial)
Acute localised otitis externa (Furuncle)
Chronic otitis externa
Eczematous otitis externa
Fungal otitis externa
Malignant otitis externa

14. Causes of OE
• Absence of cerumen (Wax)
• Removal of cerumen by ear buds
• Frequent exposure to water

15. Anti infective role of cerumen
• Protects external canal skin from moisture
• antibacterial properties
• Lowers the pH of external canal making the
environment difficult for pathogens to colonize
Role of water in otitis externa
Increases the pH of external canal making the
environment favorable for bacterial colonization

16. Acute diffuse otitis externa
• Also known as swimmer's ear
• Water exposure is the common cause
• itchy ear canal External canal diameter is
reduced due to oedema
• Conductive deafness (rare)
Chronic otitis externa
• Unrelenting pruritus
• Mild pain External canal skin appears dry
• Fungal infections commonly cause this problem

17. Managment
Treatment of infection
Removal of epithelial debris
Analgesics
Anti-inflammatory drugs

18. Otomycosis(fungal )

19. Furuncle
• Tragal sign positive
• Affects cartilagenous
portion of external
canal because of hair
follicles
• Staph aureus is the
common infecting
organism

20. Malignant otitis externa
Misnormer
Common in elderly diabetics
Pseudomonas is the causative organism
External canal granulation
Facial paralysis
Erosion of temporal bone
Nocturnal otalgia

21. 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

22. Malignant otitis externa (Images)

23. 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

24. Management of Bullous myringitis
Decompression of bullae – if otalgia is intense
Topical / oral antibiotics
Steroids
Analgesics

25. Ramsay Hunt Syndrome
Otalgia is due to irritation of 7th nerve due to Herpes
virus infection
Otalgia + Facial palsy(LMN)
Rash over ipsilateral pinna / external canal

26. Neoplasms
Primary neoplasms of pinna / external canal
Neoplasms involving skull base
Malignancy involving ceruminous glands

27. Miscellaneous causes
Trauma
Hematoma
Seroma
Frost bite
Burns / Thermal injuries

28. Middle ear causes of otalgia
Acute otitis media (AOM)
Eustachean tube dysfunction
Otitis barotrauma

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.

30. Referred otalgia
TM joint disorders
Eagle syndrome
Gerd
Neuralgias
Neoplasms of oropharynx/oral cavity
Cervical arthritis

31. Thank you