Otorrhea
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Site
Age
Type of otorrhea (mucoid,purulent)
Characteristic of drainage
(acute,pulsatile)
• Systemic disea
• ses.
• Others(otalgia,neurologic deficit)
Ear canal
• Ear trauma-cotton-tip swabs,
irrigators for cerumen removal.
• Swimming-related water contamination.
• Chronic dermatitis or eczema
• Fungal infections.
• Retained foreign body.
• External otitis , Eczema
• Acute OM with TM perforation
• Chronic OM
• Malignant OE
• Otomycosis
• Bullous myringitis
• Herpes zoster oticus
• Malignant Otitis Externa.
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-poor general health.
-immunosuppressed.
-diabetic
-suffering from Steven-Johnson’s
syndrome.
• Malignant Otitis Externa.
• -granulation tissue.
• -preauricular and auricular edema and
erythema.
• -tympanic membrane necrosis.
• -facial paralysis.
• -Pseudomonas aeruginosa.
• Otomycoses.
• Aspergillus niger-pigmented fungal
with hyphal threads.
• Candida albicans-prolonged courses of
antibiotic ear drops.
• Secondary mycosis of temporal bone.
• -Cryptococcus.-Blastomyces
• -Mucor.- Candida.
• Bullous external otitis &
myringitis.
• Hemorrhagic vesicles
• Exquisite ear pain out of proportion
to physical exam.
• Conductive hearing loss.
• Mycoplasma pneumoniae & Haemophilus
influenzae
• Ramsay Hunt syndrome.
• -vesicles with erythematous base on
EAC , pinna , or soft palate.
• -Otalgia described as a burning
sensation.
• -hearing loss.
• -vertigo.
• -facial paralysis.
• COM with or without cholesteatoma.
• Granulomatous diseases of temporal
bone (Wegener’s synd. Histiocytosis).
• Tuberculous mastoiditis.
• Neoplasms.
• Aural tuberculosis & nontuberculous
mycobacterial mastoiditis.
• -chronic painless, thin , watery or
serous otorrhea.
• -denuded malleus and multiple TM
perforations
• -granulation tissue, polyps and
inflammatory tissue, diffusely
destructive.
• Watery otorrhea = CSF leak
• Idiopathic dural dehiscence.
• Trauma.
• Complication of neoplasm , infection.
• Mondini malformation.
• Spontaneous CSF leak.
Otalgia
• Innervation.
• Anatomy.
• Causes of referred otalgia.
Tympanic branch of the glossopharyngeal nerve
(Jacobson’s nerve)
• medial surface of TM , mucosa of ME
,eustachian tube, mastoid air cells.
• Cervical roots C2 & C3 –postauricular region
• Facial N. –skin of lateral concha and antehelix,
lobule , mastoid, posterior EAC , posterior
pertion of TM
Auriculotemporal branch of the mandibular div.
of trigeminal nerve
• Tragus , anterior pinna, anterior lateral
surface of TM , anterosuperior EAC wall.
• The auricular br. Of vagus N.(Arnold’s nerve)
• -concha, inferioposterior EAC , TM ,
postauricular skin.
• Glossopharyngeal N. –oropharynx, tonsils ,
tongue base.
• Locallized otalgia.
• Acute otitis media , mastoiditis
• Otitis externa , impact cerumen.
• Eustachian tube dysfunction.
• Inflammation , infection of auricle.
• Ear trauma.
Referred otalgia
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Tonsillitis, Tongue diseases.
Thyroiditis.
Temperomandibular joint arthritis.
Periodontal , dental diseases.
Parotitis.
Sinusitis.
Laryngitis , Tracheitis.
Aural fullness
• Eustachian tube dysfunction.
• Impact cerumen.
• Meniere’s disease.
• Perilymphatic fistula.
Hearing loss
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Acute (sudden SNHL ,viral.)
Progressive (autoimmune inner ear Dz , cancer.)
Fluctuating (Meniere’s disease , multiple sclerosis.)
Systemic diseases.
Metabolic
Family history.
Others.
Hearing loss in children
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Perinatal infectionwith cytomegalovirus , rubella ,syphilis.
Family history of hereditary chilhood SNHL.
Craniofacial abnormalities.
Birth weight < 1,500 gram.
Hyperbilirubinemia.
Apgar score 0-4 at 1 min. , 0-6 at 5 min.
Syndromes (Sheibe dysplasia , Michel deformity.)
Vertigo
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Central VS Peripheral causes.
Vestibular dysfunction VS Non vestibular.
Trauma to labyrinth.
Metabolic (DM, hyperlipoproteinemia, hypothyroidism.)
Hormones.
Collagen vascular disorders.
Tumors.