SYMPTOMATOLOGY OF EAR

Symptomatology of ear
Ear discharge (otorrhoea)
Ear ache (otalgia)
Hearing loss
Tinnitus
Itching ear /Foreign body/wax ear
Giddiness/Vertigo
Swelling in pre/post auricular area
Bleeding from ear
Deformity of pinna
Autophony/hyperacusis
 Symptoms associated with ear disease

Inability to close eye

Deviation of angle of mouth
Nausea , vomiting
Light headness
Headache
Fever
Retro-orbital pain
Diplopia
 Otorrhea, or ear discharge

ear discharge usually results from an inflammatory

process in the ear canal, middle ear, or mastoid.
A thorough cleaning of the ear canal (with suction if
possible) is essential to determine the source of the
otorrhea
CSF otorrhea must always be considered in patients
with recent face or head trauma or
 Otorrhoea
Onset
 Sudden
 Insidious

Duration
 Acute
 Chronic
 Acute on chronic

Severity
 What way it disturbs you & your works.

Amount
 Scanty
 Profuse
 Otorrhoea

Laterality
 Unilateral
 Bilateral

Periodicity
 Constant
 Intermittent
 How much gap between two episode
 Is it seasonal
 Associated URTI



 Otorrhoea
Character
 Watery
 CSF otorrhoea
 Viral myringitis

 Mucoid
 Mucopurulent
 Purulent
 Blood stained

Smell
 Odorless
 Foul smelling

 Important causes
 Otitis externa (swimmer's ear)
–Most common source of otorrhea
–Usually associated with water contamination or cotton
swab abuse
–Pain with movement of pinna
–Usually secondary to Pseudomonas or Staphylococcus
infection
 Malignant otitis externa
–Also known as necrotizing external otitis and skull base
osteomyelitis
–Suspect in patients with diabetes or
immunosuppression who present with persistent
otorrhea, ear pain, and granulation tissue in the ear
canal –Usually secondary to Pseudomonas

 Important causes

Foreign body
–Frequently a retained cotton swab
–Often occurs in toddlers
Otitis media (acute or chronic) with perforated
tympanic membrane
Cholesteatoma
–A skin-lined cyst of the middle ear or mastoid that
occurs secondary to chronic otitis media
–In most cases there is fullness, bulging, or a white
mass of the tympanic membrane (may easily be
confused with ear wax)

 Important causes

Mastoiditis
–Tenderness or bogginess over mastoid
Cerebrospinal fluid otorrhea
–Clear, colorless discharge through a tympanic
membrane perforation or tympanostomy tube
–Patients usually have a history of trauma or
surgery, but CSF otorrhea may occasionally be
spontaneous

 Diagnostic workup
A thorough cleaning of the ear canal under direct
visualization (with magnification is ideal) with a
curette or suction is necessary to determine the
source of discharge
*The presence or absence of tympanic
membrane pathology must be determined
*The absence of tympanic membrane pathology
usually signifies that the source of otorrhea is
limited to the external ear canal
*Unless the ear canal is cleaned with suction,
many pathologies will not be identified
*Ear lavage should be avoided with otorrhea
 Diagnostic workup

Ear cultures from the canal may be helpful in

persistent cases; however, contamination by normal
ear canal flora usually decreases their value
If CSF otorrhea is suspected, an assay for β2
transferrin will identify CSF from other fluids
CT of the temporal bones is helpful in evaluation of
patients with suspected cholesteatoma, mastoiditis,
and CSF otorrhea
Gallium and technetium scans may be helpful in
patients with malignant external otitis

 TINNITUS
q False Perception of sound in absence of acoustic stimulus in the ear
v Ringing, Hissing, Humming, Roaring, Buzzing, tickling
 Duration
 Laterality
 Unilateral- Usually local
 Bilateral – usually central cause
 Periodicity
 Constant
 Intermittent
 Severity
 Tolerable
 Unable to sleep
 Tinnitus & different ear
disorders :
External ear:
-Wax Middle ear:
-Foreign body -Otosclerosis
-Otitis externa -Otitis Media
-Glomus juglare
tumour
Cochlea: Retro-
-Noise induced
-Presbyacusis cochlear:
-Meniere’s disease -Acoustic
-Ototoxicity Neuroma
 TINNITUS
Non treatable cause of tinnitus:
•Noise induced hearing loss
•Acoustic trauma
•Ototoxicity
•Presbyacusis
Treatable causes of tinnitus:
Impacted cerumen
Ear infection
Ruptured tympanic membrane
Otosclerosis
Meniere’s disease
Acoustic neuroma
TMJ dysfunction
 Earache

E a r p a i n i s a n e x t r e m el y c o m m o n
presenting complaint in both
p r i m a r y c a r e a n d o t o l a r y n g o l o gy
practice.
 Important causes

Otitis media
–Most cases are of viral origin
–Red tympanic membrane with decreased mobility

Eustachian tube dysfunction

–Common in young children

 Important causes

Otitis externa
–Pain upon movement of tragus
Malignant (necrotizing) otitis externa
–Usually due to Pseudomonas –Mostly seen in
diabetics

 Referred otalgia


–TMJ: May result in ear pain, jaw pain, neck
pain, and/or headache
–Dental infection, trauma, or orthodontic
intervention (e.g., tightening of braces)
–Pharyngitis or tonsillitis
–Post-tonsillectomy/adenoidectomy


 Referred otalgia

–Retropharyngeal abscess and other ENT deep-space

infections
–Cervical adenitis
–Sinusitis/rhinitis
–Laryngitis
–Trigeminal neuralgia
–Esophagitis
–Cervical spine arthritis
–Parotiditis/sialoadenitis (including mumps)
–Angina/acute coronary syndrome
 Important causes

 Trauma: Laceration, abrasion, barotrauma (e.g., deep sea

diving, airplane)
 Cellulitis
 Tympanostomy tube obstruction
 Myringitis bullosa
 Furunculosis (localized abscess)
 Varicella or herpes simplex/zoster infection in the ear canal
 Mastoiditis
–Ear protrudes anteriorly
 Tumor
 Eczema/psoriasis
 Mumps

 Otalgia

Onset
 Sudden
 Insidious

Duration
 Unilateral/Bilateral
 Constant/intermittant
 Static/progressive
Severity
 What way it disturbs you & your works.
 Otalgia

Character
 Dull aching, stabbing, cutting or pricking
Aggravating factors
Relieving factors
Referred pain
 Workup and Diagnosis

History and physical examination, including otoscopic

exam with pneumatic otoscopy and complete head
and neck examination
–Pain upon traction of pinna suggests otitis externa
(hyperemic external canal)
–Bulging, red, immobile tympanic membrane is
consistent with acute otitis media (with or without
otorrhea secondary to perforation)
–
 Workup and Diagnosis

qRetracted, immobile tympanic membrane may be

seen in serous otitis media
q
–Mass lesion behind tympanic membrane suggests
cholesteotoma or tumor
q
–Tonsillar asymmetry or uvular deviation suggests
peritonsillar abscess or mass
q
qTympanometry may reveal otitis media with
effusion, eustachian tube dysfunction, or
tympanostomy tube obstruction
qAudiometry to evaluate for hearing loss
qConsider culture of otorrhea if perforation (not
canal) or complicated (e.g., recurrent infection,
spread of infection such as meningitis or
mastoiditis)
q
Lateral neck X-ray will diagnose retropharyngeal
mass or abscess
Head CT is indicated if intracranial lesion or basilar
skull fracture is suspected
Consider CBC and ESR if suspect malignant
necrotizing otitis media
Check glucose in recurrent severe otitis externa

 Autophony/ Hypercusis

Autophony
 Hears own voice when speaking
 OME
 Abnormal Eustachian tube



Hypercusis
Undue sensitivity of loud sound sound
 Stapedial nerve paralysis

 Bleeding from ear

Onset
Duration
 Unilateral/Bilateral
 Constant/intermittant
 Static/progressive
History suggestive of aetiology
 Post traumatic (sever head injury, barotraumas,
physical assult)
 Haemangioma, glomus jugular tumour
Swelling in pre/post auricular area
Blunt trauma
Cauliflower ear

Auricular Hematoma
 Foreign Body Ear

qEmergency when
associated with
vertigo, profound
hearing loss and/ or
facial paralysis
qDo not irrigate
organic material or
with a perforation
qOtologic examinaion
reveals FB
q
 Cerumen

Ear wax is a mixture of secretions from

ceruminous and pilosebaceous glands and
squames of epithelium, dust, and other
debris.

 Cerumen
qPatients present complaining of loss of hearing,
tinnitus, vertigo, otalgia, aural fullness, cough
(reflexive through stimulation of the auricular
branch)
qPredisposing factors: hairy ear canals, narrow ear
canals, osteomata, in-the-ear hearing aids.
qTreatment
q Ceruminolytics
qBicarbonate solution
qOlive oil
qGlycerine
 SYRINGING

 Indications for Ear Syringing

Totally occlusive cerumen with,Pain Reduced hearing
Tinnitus
 Otitis externa if ear suctioning apparatus not available

 Contraindications to Ear Syringing

 Non-occlusive cerumen
 Previous ear surgery (including ventilation tubes)
 Only hearing ear
 Known tympanic membrane perforation
 Age under 16 years (debatable)
 Syringing
q
qIf wax appears hard, use a ceruminolytic for a few
days prior to syringing
qWarm tap water or saline to about 37oC
qClean, smoothly functioning manual syringe