ENT
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Otolaryngology/ Otorhinolaryngology
ENT Head & Neck Surgery
Gateways of body
Special senses. Taste, hearing, Smell,
Balance
Narrow cavities. Special equipment
Complex anatomy
EARACHE
OR
OTALGIA
Sensory Supply Of the Ear
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5th CN - Auriculotemporal branch
1st and 2nd cervical nerves.
9th CN - Jacobson branch
10th CN- Arnold branch
7th CN - Ramsey hunt branch
EAR ACHE / OTALGIA
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Types
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Primary otalgia
Referred otalgia.
EVALUATION OF OTALGIA
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History
 Ear symptoms
 Nasal symptoms
 swallowing disorders
 recent trauma
 General Symptoms
Examination
 Genral physical examination
 Complete ENT examination
 Rhinoscopy, nasopharyngoscopy, and indirect laryngoscopy.
 Palpation of the neck is important to look for thyroid disease
and 1lymphadenopathy
PRIMARY OTALGIA
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PINNA
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Trauma
Haematoma
Infected Eczema
Frost Bite
Sunburn
Chondrodermatitis nodularis chronica helicis
Infected Basal Cell/Squamaous cell Ca
PRIMARY OTALGIA
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Meatus
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Impacted Wax
Keratosis Obturans
Boil
Otitis Externa
Malignant Otitis externa
Herpes Zoster Oticus
Trauma
PRIMARY OTALGIA
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Middle Ear
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Acute Otitis Media
Otitic Barotrauma
Bullous Myringitis
Haemotympanum
Carcinoma
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Complicated CSOM
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Acute Mastoiditis
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Inner Ear
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Noise
Tinnitus described as throbbing pain
REEFERRED EAR ACHE
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Tonsillitis
Nasal Polyps
Mumps
Thyroid disease’s
Laryngitis
Long Styloid Process
Dental Abnormalities
Oral Ulceration
TMJ Disordres
IMPACTED WAX
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Normal secretion of ceruminous glands
Cause of impaction
Pain, deafness, tinnitus,
Removal
Prevention
EAR WAX
FURUNCLOSIS EAR (Boil)
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Staphylococal Infection hair follicle of Ext Meatus
Clinical Features
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Pain full swelling in outer 1/3rd of ext auditory canal
Discomfort aggravated on movement of jaw
Deafness
Treatment
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Aural dressing
 Antibiotic & Steroid Cream or icthamol
Antibiotics
 Cloxacillin,Flucloxacillin,Cephradine
Analgesics
Most drain spontaneously
Blood Sugar Levels
FURUNCLE
FURUNCLE
FURUNCLE
Diffuse Otitis Externa
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Diffuse inflammation of meatal skin
Aetiology
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Hot humid climate
Swimmers
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Trauma
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Unskilled instrumentation
Scratching ear canal with hair pin
Excessive cleaning of ear canal after swimming
Existing CSOM
Causative Organisms
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Pseudomonas aeruginosa
Staph.aureus
B.proteus
Diffuse Otitis Externa
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Clinical features
 Hot burning sensation
 Pain
 Serous or purulent discharge
 Meatal skin is red warm and tender
 Cheesy debris in the deep meatus
Treatment
 Aural toilet
 Aural dressing
 Topical antibiotics with steroids
MALIGNANT OTITIS EXTERNA
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Progressive infection of meatus, surrounding soft
tissue and skull base
Causative Organism
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Pseudomonas aeroginosa
Predisposing Factors
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Elderly diabetics
Immunocompromised
MALIGNANT OTITIS EXTERNA
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Clinical Features
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Excruciating Pain
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Granulations in the Ext ear canal
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IX, X, XI CN palsies
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Intracranial complications
Treatment
 I/V Antibiotics high doses 6-8 weeks
 Glycemic control
 Debridement of devitalized tissue & bone
HERPES ZOSTER OTICUS
HERPES ZOSTER OTICUS
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Viral Infection affecting genicualte ganglion of facial
nerve
Clinical Features
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Severe otalgia
Vesicular rash on the concha or pinna
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VII Nerve Palsy (Ramsay Hunt Synd.)
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Treatment
 Oral acyclovir
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Pain continues months after the rash as post
herpetic neuralgia requiring
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Tricyclic antidepressants
OTOMYCOSIS
OTOMYCOSIS
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Fungal Infection of ear canal
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Aspergilis niger, Aspergilis fumigatis, Candida albicans
Predisposing Factors
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Hot & Humid climate
Topical antibiotics drops for CSOM or otitis externa
OTOMYCOSIS
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Clinical Features
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Itching
pain in ear
Discharge with musty color
Fungal mass looks like Wet piece of filter paper
Treatment
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Aural Toilet
Antifungal Agents
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Clotrimazole
2% salicylic acid in alcohal
REACTIVE OTITIS EXTERNA
ACUTE OTITIS MEDIA
ACUTE OTITIS MEDIA
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Acute Infection of middle ear by pyogenic organisms.
Common in infants and children
Bacteriology
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Strep.Pneumonae,H INF, Moraxella Catarrhalis
Clinical Features
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Otalgia,Fever,Ear discharge
Red Congested buldging TM
Small Perforation with ear discharge
ACUTE OTITIS MEDIA
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Managememnt
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Antibiotics
Antipyretics
Decongestants
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Systemic,Topical
Ear Toilet
Myringotomy
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Pain Not responding to above treatmenty
Development of complications
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Facial paralysis etc
OTITIC BAROTRAUMA
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Non suppurative condition due to failure of
eustacchian tube to maintain middle ear pressure at
ambient atmospheric level
Mechanism
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When atmospheric pressure is higher than middle ear
pressure by a critical of 90 mm of hg eustachian tube gets
locked.- -ve pressure in middle ear - retraction of
tympanic membrane-hyperaemia,transudation and
haemorrhage in the middle ear.
OTITIC BAROTRAUMA
OTITIC BAROTRAUMA
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Treatment
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Nasal decongestants
Antihistamines
Myringotomy
Prevention
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Swallow during descent
Donot sleep during descentdecreases swallows Effects opening
of eustachians tube
Autoinflation of tube by valsalva during descent.
ACUTE MASTOIDITIS
Acute Mastoiditis
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Inflammation of mucosal lining of antrum and
mastoid air cell system.
Clinical Features
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Pain behind the ear
Fever
Ear Discharge
Mastoid tenderness
Ear discharge
Sagging of posterosuperior meatal wall
Swelling over the mastoid
Deafness
Acute Mastoiditis
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Antibiotics
Myringotomy
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Pus under tension not resolving with medical therapy
Cortical Mastoidectomy
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Subpreiosteal abscess
Positive reservoir sign
No change in symptoms after 48 hrs of medical management
Complications
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Facial palsy, labrynthitis,intracranial complications.
ACUTE TONSILLITIS- referred otalgia
PERITONSILLAR ABSCESS-
Referred otalgia
LARYNGITIS- Referred otalgia
THYROID DISEASE- referred otalgia
APHTHUS ULCER
-Referred otalgia
LONG STYLOID PROCESS-Referred otalgia
THANKS
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