External Ear Disorders

1. OTALGIA
BY,
VEDANTHA VINOD
ASSISTANT LECTURER
CCON-MYSORE

2.  INTRODUCTION
 MEANING
 TYPES
 ETIOLOGY
 RISK FACTORS
 PATHOPHYSIOLOGY
 CLINICAL MANIFESTATIONS
 MANAGEMENT
 PRECAUTIONS
CONTENTS TO BE DISCUSSED:-

3. INTRODUCTION
Pain in the inner or outer ear
that may interfere with ability to
hear ,often caused by excess
fluid and infection.

4. • Is defined as pain in the ear or ear
ache.
MEANING

5. TYPES
• Primary Otalgia
• Referred Otalgia

6. PRIMARY OTALGIA
pain that originates within the
ear is primary otalgia. Typical
sources of primary otalgia are
external otitis , otitis media ,
mastoiditis, and auricular
infections.
The ear can be anatomically
divided into the external ear,
the external auditory canal, the
middle ear, and the inner
ear. These three are

7. REFERRED OTALGIA
 Many different nerves provide sensation to
the various parts of the ear.
 Includes cranial nerves V (trigeminal), VII
(facial), IX (glossopharyngeal), and X (vagus),
and the great auricular nerve (cervical nerves
C2-C3).
 These nerves also supply other parts of the
body, from the mouth to the chest and
abdomen. Irritation of these nerves in
another part of the body has the potential to
produce pain in the ear. This is called
referred pain. Irritation of the trigeminal

8. REFERRED OTALGIA FROM NECK AND HEAD

9. ETIOLOGY OF PRIMARY OTALGIA
• Laceration & bite
• Hematoma
• Otitis externa
• Perichondritis
• Infected pre-auricularsinus
• Frostbite, sunburn
• Neoplasm
Pinna External auditory canal
• Impacted wax
• Foreign body
• Keratosis obturans
• Otitis externa
• Herpes zoster oticus
• Exostoses
• Neoplasm

10. Middle Ear
• Bullous myringitis
• Acute otitis media
• Hemotympanum
• Otitic barotrauma
• Neoplasm
Mastoid
• Mastoiditis
• Mastoid abscess
• Granulomas
• Secretory otitis media
• Neoplasm
• Traumatic perforation
Inner ear
• Acoustic trauma
• Meniere’s disease
• Vestibular schwannoma

11. CHOLESTEATOMA
• It is a cyst in the middle ear or mastoid
system that is lined with squamous
epithelium and filled with keratin debris.
• It occurs due to COM

12. ETIOLOGY OF REFERRED
OTALGIA

13. • Teeth: infection, impacted 3rd molar, malocclusion
• Oral cavity: infection, ulcer, malignancy, Ludwig’s
angina, sialadenitis, salivary calculus
• Temporo-mandibular joint: arthritis, dysfunction
• Nose & PNS: impacted DNS, sinusitis, neoplasm
• Nasopharynx: infection, post- adenoidectomy,
adenoiditis, tumor
• Trigeminal neuralgia
A. VIA TRIGEMINAL NERVE

14. B. VIA GLOSSOPHARYNGEAL NERVE
• Tonsil: tonsillitis, peritonsillar abscess, post-
tonsillectomy, neoplasm
• Oropharynx: infection, ulcer, retropharyngeal +
parapharyngeal abscess, trauma, neoplasm
• Eagle’s syndrome (stylalgia)
• Glossopharyngeal neuralgia

15. C. VIA FACIAL NERVE:
Herpes zoster oticus, vestibular schwannoma
Larynx
D. VIA VAGUS NERVE:
+ hypopharynx: neoplasm, infection,
tuberculosis, trauma,
foreign body
E. VIA SECOND & THIRD CERVICAL NERVES:
Herpes zoster, cervical spondylosis & arthritis

16. RISK FACTORS
• Insertion of unclean/sharp articles into the ear
• Instillation of contaminated solutions
• Swimming in polluted water
• Recent Upper Respiratory Tract Infection
• Eustachian tube dysfunction
• Allergies

17. PATHOPHYSIOLOGY
Trauma or infection
Inflammation
Release of inflammatory mediators &
chemotaxis of leukocytes
Tissue edema, pain, heat and redness

18. CLINICAL MANIFESTATIONS
 Ear pain can present in one or both ears.
 It may or may not be accompanied by other symptoms
such as
 Fever,
 Sensation of the world spinning, ear itchiness, or a
sense of fullness in the ear.
 The pain may or may not worsen with chewing.
 The pain may also be continuous or intermittent.
 Ear pain due to an infection is the most common in
children and can occur in babies.
 Adults may need further evaluation if they have
hearing loss, dizziness or ringing in the ear.
 Additional red flags include diabetes, a weakened
immune system, swelling seen on the outer ear, or

19. MANAGEMENT
• Promote healing :
– Ear irrigation
– Antibiotics
• Alleviate pain :
– Analgesics
• Restore normal function and remove foreign
bodies:

20. SURGICAL MANAGEMENT
• Myringoplasty : Closure of simple perforation
of tympanic membrane.
• Tympanoplasty: Surgical correction of the
perforated Tympanic membrane.
• Ossiculoplasty: Ossicular reconstruction
• Myringotomy: An incision to the tympanic
membrane through which fluid is removed.
• Mastoidectomy:

21. PRECAUTIONS AFTER EAR
SURGERY
• Client must lye with operated ear up for
several hours after surgery.
• If necessary, the client should blow the nose
gently one side at a time.
• The client should sneeze or cough with the
mouth open for 1 week after surgery.
• Participation in water sports or activities is
prohibited.

22. • Avoid physical activity for 1 week & exercise or
sports for 3 weeks after surgery.
• Avoid heavy lifting.
• Change the cotton ball in the ear daily.
• Keep the ear dry for 4-6 weeks.
• Do not shampoo for 1 week.
• Avoid airplane flights for the first week after
surgery. For sensation of ear pressure , hold
your nose, close your mouth and swallow to
equalize pressure.
• Wear noise defenders in loud environments.
• Inform in case of bleeding from ear.

23.  INTRODUCTION
 MEANING
 TYPES
 ETIOLOGY
 RISK FACTORS
 PATHOPHYSIOLOGY
 CLINICAL MANIFESTATIONS
 MANAGEMENT
 PRECAUTIONS
DISCUSSED CONTENTS:-