Causes of Ear infection
Ear infection Causes: Book Excerpts
Ear infection as a complication of other conditions:
Other conditions that might have
Ear infection as a complication may,
potentially, be an underlying cause of Ear infection.
Our database lists the following as having
Ear infection as a complication of that condition:
Ear infection as a symptom:
Conditions listing Ear infection
as a symptom may also be potential underlying causes of Ear infection.
Our database lists the following as having
Ear infection as a symptom of that condition:
Medications or substances causing Ear infection:
The following drugs, medications, substances or toxins are some of the possible
causes of Ear infection as a symptom.
This list is incomplete and various other drugs or substances
may cause your symptoms.
Always advise your doctor of any medications or treatments you are using,
including prescription, over-the-counter, supplements, herbal or alternative treatments.
Read more about medication causes of Ear infection
What causes Ear infection?
Causes: Ear infection:
Streptococcus pneumoniae causes thousands of cases of
meningitis and pneumonia, and 7 million cases of ear infection in
the United States each year. (Source: excerpt from Antimicrobial Resistance, NIAID Fact Sheet: NIAID)
Related information on causes of Ear infection:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Ear infection may be found in:
Causes of Ear infection: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Ear infection.
Hearing Loss:
Differential Diagnosis
(In a Page: Signs and Symptoms)
Conductive hearing loss: Results from any process preventing sound from reaching the inner ear
–Obstruction of the ear canal, usually due to cerumen impaction or foreign body
–Otitis media with middle ear effusion (most common in children but also occurs in adults)
–Chronic otitis media: Permanent change in the ear (e.g., tympanic membrane perforation, ossicular chain discontinuity and fixation, cholesteatoma) secondary to otitis media
–Congenital atresia of the external auditory canal
- Sensorineural hearing loss: Nerve type hearing loss, either in the inner ear or the auditory nerve
–Presbycusis is the most common form
–Noise-induced hearing (occupational or nonoccupational)
–Hereditary sensorineural hearing loss, usually autosomal recessive heritance
–Medications (e.g., aminoglycosides, chemotherapeutics, diuretics)
–Ménie're's disease: Hearing loss, tinnitus, vertigo, and aural fullness
–Acoustic neuroma: Results in unilateral hearing loss and tinnitus as the initial symptoms in 90% of patients
–Alport's syndrome: Hereditary nephritis, sensorineural deafness, ocular abnormalities)
- Mixed hearing loss (both conductive and sensorineural hearing loss)
–Wardenberg's syndrome
–Prolonged QT syndrome variant
–Other causes of congenital deafness
–Meningitis
–Vascular (e.g., embolism, thrombosis,
hemorrhage)
–Viral (e.g., mumps, measles, influenza, varicella, adenovirus, EBV)
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Otorrhea:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- 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
-
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)
- 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
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Ear Pain:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Otitis media
–Most cases are of viral origin
–Red tympanic membrane with decreased mobility
–Male > female; peak incidence 6–18 months
–Risk factors include day care, supine bottle feeding, smoking in household, siblings with otitis media, anatomic abnormalities (e.g., Down's syndrome)
-
Eustachian tube dysfunction
–Common in young children
-
Otitis externa
–Pain upon movement of tragus
-
Malignant (necrotizing) otitis externa
–Usually due to Pseudomonas –Mostly seen in diabetics
- Referred pain
–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
–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
-
Foreign body in ear canal (including impacted cerumen)
-
Reaction to topical agents
-
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
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Otorrhea (Ear Discharge):
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Cerumen
–Often brownish color
–Rarely associated with otalgia or pruritis
- Otitis externa
–Bacterial (frequently Pseudomonas and Staphylococcus aureus) vs fungal (especially after prolonged treatment with antibiotic drops)
–Concern: Necrotizing (malignant) otitis externa (i.e., temporal bone osteomyelitis) in immunosuppressed patients, including brittle diabetics
-
Acute otitis media with tympanic membrane (TM) perforation
–Acute perforation may already have closed by the time the patient is examined
-
Chronic perforation drainage
–From water contamination (swimming, bathing) if patient is not maintaining dry ear precautions (ear plugs, occlusive head bands, shower caps, etc.)
-
Tympanostomy tube drainage
–If bloody, suspect granulation tissue surrounding the tube
–Increased incidence when not maintaining dry ear precautions is debated (as small tube lumen diameter has considerable surface tension)
-
Chronic suppurative otitis media
–Chronic middle ear and/or mastoid infection with perforated TM
-
Cholesteatoma
–“Skin cyst” (keratinizing stratified squamous epithelium) in the middle ear/mastoid
–Benign, but often very aggressively locally
erosive (mechanical and enzymatic)
–Surgical, not medical, condition
-
Perichondritis
–Spares the lobule (as there is no cartilage there)
-
Myringitis
–TM granulation or de-epithelialization
-
Foreign body
-
CSF leak
–Watery drainage
–Traumatic or congenital
–With or without perilymphatic fistula
-
Primary dermatologic condition
–Eczema, psoriasis
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Otalgia (Ear Pain):
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
External ear
-
Otitis externa
–Pinnae and especially tragus, are exquisitely tender
-
Impacted cerumen
–Hearing loss and aural fullness
-
Foreign body
–Items such as beads, toys, and even extruded tympanostomy tubes
-
Trauma
–Any object inserted into the ear canal may cause trauma, including Q-tips
-
Perichondritis
–Inflammation or infection of the cartilage of the pinna and canal, sparing the lobule (since there is no cartilage there)
-
Myringitis
–Tympanic membrane granulation or de-epithelialization
Middle ear/mastoid
-
Acute otitis media
–Otalgia may precede middle ear effusion
-
Otitis media with effusion
–May occur in the absence or presence of an active infection
-
Eustachian tube dysfunction
–Negative intratympanic pressure
-
Barotrauma
–Pretreatment with topical nasal decongestants may be effective prophylaxis
-
Mastoiditis
–Associated with postauricular pain and normal tympanic membrane/middle ear
Non-otologic (secondary)
-
Cranial nerve referred pain
–III: Dental infection, temporal-mandibular joint (TMJ) syndrome
–VII: Herpes zoster oticus (Ramsay Hunt
syndrome)
–IX: Tonsillitis, pharyngitis
–X: Laryngitis, GERD, thyroiditis
-
Cervical nerve referred pain
–Neck infections, lymph nodes, cysts
–Cervical spine disorders
-
Paranasal sinusitis
-
Migraines
-
Neuralgias
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Hearing Loss – Acquired:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
Conductive (CHL)
-
Cerumen impaction
-
External auditory canal foreign body
-
Middle ear effusion (MEE)
–Frequently follows acute otitis media
-
Tympanic membrane (TM) perforation
–Usually due to trauma, chronic otitis media
-
Cholesteatoma
–Acquired cholesteatoma is accompanied by TM retraction or perforation
–Congenital cholesteatoma is usually over an intact TM
-
Ossicular erosion or fixation due to middle ear disease
-
Ossicular chain discontinuity (generally posttraumatic)
-
External auditory canal stenosis from chronic otitis externa
-
Middle ear tumor
–Paraganglioma (glomus tympanicum), facial neuroma, histiocytosis X, etc.
Sensorineural (SNHL)
-
Meningitis, especially bacterial
-
Viral, especially mumps
-
Autoimmune disease
–Vasculitis, scleroderma, Kawasaki disease
–Idiopathic
-
Acoustic trauma (noise-induced)
-
Ototoxic medications
–Aminoglycosides
–Diuretics (especially loop diuretics)
–Salicylates
–Cytotoxic (chemotherapeutic) agents, e.g., cisplatinum
-
Temporal bone fracture
–SNHL more likely with transverse than longitudinal fracture
-
Perilymphatic fistula (PLF)
–Hearing loss may be progressive or
fluctuating
- Cerebellopontine angle (CPA) tumor
–Vestibular schwannoma (a.k.a. acoustic neuroma, associated with type II neurofibromatosis), meningioma, etc.
–SNHL will be unilateral - Ménière disease
–Characterized by hearing loss, vertigo, tinnitus, sensation of aural fullness
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Hearing Loss – Congenital:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Infections
–CMV: Most common intrauterine infection
causing hearing loss
–Bacterial meningitis
–Congenital rubella: Cataracts, cardiovascular
anomalies, retinitis, mental retardation
–Congenital syphilis
–Toxoplasmosis
–Lyme disease - Metabolic
–Hyperbilirubinemia (kernicterus): Consider phototherapy or exchange transfusion if serum bilirubin >20 mg/dL in newborn
–Hypercholesterolemia
-
Ototoxic medications
–Aminoglycoside, gentamicin often needed for perinatal sepsis; >5 days risks hearing loss
-
Temporal bone anomaly
–Middle ear anomaly (results in conductive
hearing loss)
–Perilymphatic fistula
–Dilated vestibular aqueduct (±Mondini
deformity)
–Michel cochlear aplasia
–Scheibe aplasia: Membranous aplasia; bony
labyrinth normal
-
Nonsyndromic hereditary congenital deafness (connexin 26 gene mutation is responsible for half of all genetic deafness)
-
Syndromic hereditary congenital deafness
–Waardenburg: Telecanthus, confluent eyebrow, colored irides, white forlock
–Usher: Retinitis pigmentosa (totally blind by second to third decade), ataxia, vestibular dysfunction
–Alport: Progressive nephritis and hearing loss
–Apert (acrocephalosyndactyly): Craniofacial dysostosis
–Crouzon (craniofacial dysostosis): Prognathic mandibile, small maxilla
–Jervell and Lange-Neilsen: Heart disease
(prolonged QT interval)
–Pendred: Euthyroid goiter
–Oto-palatal-digital: Cleft palate, stubby
clubbed digits
–Congential aural atresia
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Earache:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Abscess (extradural)
Severe earache accompanied by a persistent ipsilateral headache, malaise, and a recurrent mild fever characterizes an abscess, which is a serious complication of middle ear infection.
Barotrauma (acute)
Earache associated with barotrauma ranges from mild pressure to severe pain. Tympanic membrane ecchymosis or bleeding into the tympanic cavity may occur, producing a blue drumhead; the eardrum usually isn't perforated.
Cerumen impaction
Impacted cerumen (earwax) may cause a sensation of blockage or fullness in the ear. Additional features include partial hearing loss, itching and, possibly, dizziness.
Herpes zoster oticus (Ramsay Hunt syndrome)
Herpes zoster oticus causes burning or stabbing ear pain, commonly associated with ear vesicles. The patient also complains of hearing loss and vertigo. Associated signs and symptoms include transitory, ipsilateral, facial paralysis; partial loss of taste; tongue vesicles; and nausea and vomiting.
Keratosis obturans
Mild ear pain is common with keratosis obturans, along with otorrhea and tinnitus. Inspection reveals a white glistening plug obstructing the external meatus.
Mastoiditis (acute)
Mastoiditiscauses a dull ache behind the ear accompanied by a low-grade fever (99 to 100 F [37.2 to 37.87 C]). The eardrum appears dull and edematous and may perforate, and soft tissue near the eardrum may sag. A purulent discharge is seen in the external canal.
Ménière's disease
Ménière's disease is an inner ear disorder that can produce a sensation of fullness in the affected ear. Its classic effects, however, include severe vertigo, tinnitus, and sensorineural hearing loss. The patient may also experience nausea and vomiting, diaphoresis, and nystagmus.
Otitis externa
Earache characterizes acute and malignant otitis externa. Acute otitis externa begins with mild to moderate ear pain that occurs with tragus manipulation. The pain may be accompanied by a low-grade fever, sticky yellow or purulent ear discharge, partial hearing loss, and a feeling of blockage. Later, ear pain intensifies, causing the entire side of the head to ache and throb. Fever may reach 104 F (40 C). Examination reveals swelling of the tragus, external meatus, and external canal; eardrum erythema; and lymphadenopathy. The patient also complains of dizziness and malaise.
Malignant otitis externa abruptly causes ear pain that's aggravated by moving the auricle or tragus. The pain is accompanied by intense itching, purulent ear discharge, a fever, parotid gland swelling, and trismus. Examination reveals a swollen external canal with exposed cartilage and temporal bone. Cranial nerve palsy may occur.
Otitis media (acute)
Otitis media is middle ear inflammation that may be serous or suppurative. Acute serous otitis media may cause a feeling of fullness in the ear, hearing loss, and a vague sensation of top-heaviness. The eardrum may be slightly retracted, amber, and marked by air bubbles and a meniscus, or it may be blue-black from hemorrhage.
Severe, deep, throbbing ear pain; hearing loss; and a fever that may reach 102 F (38.9 C) characterize acute suppurative otitis media.
The pain increases steadily over several hours or days and may be aggravated by pressure on the mastoid antrum. Perforation of the eardrum is possible. Before rupture, the eardrum appears bulging and fiery red. Rupture causes purulent drainage and relieves the pain.
Chronic otitis media usually isn't painful except during exacerbations. Persistent pain and discharge from the ear suggest osteomyelitis of the skull base or cancer.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Hearing loss:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Acoustic neuroma
Acoustic neuroma, which is a CN VIII tumor, causes unilateral, progressive, sensorineural hearing loss The patient may also develop tinnitus, vertigo, and — with cranial nerve compression — facial paralysis.
Adenoid hypertrophy
Eustachian tube dysfunction causes gradual conductive hearing loss accompanied by intermittent ear discharge The patient also tends to breathe through his mouth and may complain of a sensation of ear fullness.
Aural polyps
If a polyp occludes the external auditory canal, partial hearing loss may occur The polyp typically bleeds easily and is covered by a purulent discharge.
Cholesteatoma
Gradual hearing loss is characteristic It can be accompanied by vertigo and, at times, facial paralysis
Examination reveals eardrum perforation, pearly white balls in the ear canal, and possible discharge.
Cyst
Ear canal obstruction by a sebaceous or dermoid cyst causes progressive conductive hearing loss On inspection, the cyst looks like a soft mass.
External ear canal tumor (malignant)
Progressive conductive hearing loss is characteristic and is accompanied by deep, boring ear pain, purulent discharge and, eventually, facial paralysis Examination may detect the granular, bleeding tumor.
Glomus jugulare tumor
Initially, this benign tumor causes mild, unilateral conductive hearing loss that becomes progressively more severe The patient may report tinnitus that sounds like his heartbeat
Associated signs and symptoms include gradual congestion in the affected ear, throbbing or pulsating discomfort, bloody otorrhea, facial nerve paralysis, and vertigo. Although the tympanic membrane is normal, a reddened mass appears behind it.
Head trauma
Sudden conductive or sensorineural hearing loss may result from ossicle disruption, ear canal fracture, tympanic membrane perforation, or cochlear fracture associated with head trauma Typically, the patient reports a headache and exhibits bleeding from his ear
Neurologic features vary and may include impaired vision and an altered level of consciousness.
Ménière’s disease
Initially, Ménière’s disease, an inner ear disorder, produces intermittent, unilateral sensorineural hearing loss that involves only low tones Later, hearing loss becomes constant and affects other tones
Associated signs and symptoms include intermittent severe vertigo, nausea and vomiting, a feeling of fullness in the ear, a roaring or hollow-seashell tinnitus, diaphoresis, and nystagmus.
Nasopharyngeal cancer
Nasopharyngeal cancer causes mild unilateral conductive hearing loss when it compresses the eustachian tube
Bone conduction is normal, and inspection reveals a retracted tympanic membrane backed by fluid. When this tumor obstructs the nasal airway, the patient may exhibit nasal speech and a bloody nasal and postnasal discharge. Cranial nerve involvement produces other findings, such as diplopia and rectus muscle paralysis.
Otitis externa
Conductive hearing loss resulting from debris in the ear canal characterizes acute and malignant otitis externa With acute otitis externa, ear canal inflammation produces pain, itching, and a foul-smelling, sticky yellow discharge
Severe tenderness is typically elicited by chewing, opening the mouth, and pressing on the tragus or mastoid. The patient may also develop a low-grade fever, regional lymphadenopathy, a headache on the affected side, and mild to moderate pain around the ear that may later intensify. Examination may reveal greenish white debris or edema in the canal.
With malignant otitis externa, debris is also visible in the canal. This life-threatening disorder, which most commonly occurs in the patient with diabetes, causes sensorineural hearing loss, pruritus, tinnitus, and severe ear pain.
Otitis media
Otitis media is a middle ear inflammation that typically produces unilateral conductive hearing loss In patients with acute suppurative otitis media, the hearing loss develops gradually over a few hours and is usually accompanied by an upper respiratory tract infection with a sore throat, cough, nasal discharge, and headache. Related signs and symptoms include dizziness, a sensation of fullness in the ear, intermittent or constant ear pain, a fever, nausea, and vomiting. Rupture of the bulging, swollen tympanic membrane relieves the pain and produces a brief, bloody, purulent discharge. Hearing returns after the infection subsides.
Hearing loss also develops gradually in patients with chronic otitis media. Assessment may reveal a perforated tympanic membrane, purulent ear drainage, an earache, nausea, and vertigo.
Commonly associated with an upper respiratory tract infection or nasopharyngeal cancer, serous otitis media commonly produces a stuffy feeling in the ear and pain that worsens at night. Examination reveals a retracted — and perhaps discolored — tympanic membrane and possibly air bubbles behind the membrane.
Otosclerosis
Otosclerosis is a hereditary disorder in which unilateral conductive hearing loss usually begins when the patient is in his early twenties and may gradually progress to bilateral mixed loss The patient may report tinnitus and an ability to hear better in a noisy environment
The deafness is usually noticed between ages 11 and 30.
Gender cue
Otosclerosis affects twice as many women as men, and the condition may worsen during pregnancy.
Skull fracture
Auditory nerve injury causes sudden unilateral sensorineural hearing loss Accompanying signs and symptoms include ringing tinnitus, blood behind the tympanic membrane, scalp wounds, and other findings.
Temporal bone fracture
Temporal bone fracture can cause sudden unilateral sensorineural hearing loss accompanied by hissing tinnitus The tympanic membrane may be perforated, depending on the fracture’s location
Loss of consciousness, Battle’s sign, and facial paralysis may also occur.
Tympanic membrane perforation
Commonly caused by trauma from sharp objects or rapid pressure changes, perforation of the tympanic membrane causes abrupt hearing loss along with ear pain, tinnitus, vertigo, and a sensation of fullness in the ear.
Other causes
Drugs
Ototoxic drugs typically produce ringing or buzzing tinnitus and a feeling of fullness in the ear Chloroquine, cisplatin, vancomycin, and aminoglycosides (especially neomycin, kanamycin, and amikacin) may cause irreversible hearing loss
Loop diuretics, such as furosemide, ethacrynic acid, and bumetanide, usually produce a brief, reversible hearing loss. Quinine, quinidine, and high doses of erythromycin or salicylates (such as aspirin) may also cause reversible hearing loss.
Radiation therapy
Irradiation of the middle ear, thyroid, face, skull, or nasopharynx may cause eustachian tube dysfunction, resulting in hearing loss
Surgery
Myringotomy, myringoplasty, simple or radical mastoidectomy, or fenestrations may cause scarring that interferes with hearing.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Otorrhea:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Aural polyps
Aural polyps may produce foul, purulent and, perhaps, blood-streaked discharge. If they occlude the external ear canal, the polyps may cause partial hearing loss.
Basilar skull fracture
With a basilar skull fracture, otorrhea may be clear and watery and positive for glucose, representing cerebrospinal fluid (CSF) leakage, or bloody, representing hemorrhage. Occasionally, inspection reveals blood behind the eardrum. Otorrhea may be accompanied by hearing loss, CSF or bloody rhinorrhea, periorbital ecchymosis (raccoon eyes), and mastoid ecchymosis (Battle’s sign). Cranial nerve palsies, a decreased level of consciousness, and a headache are other common findings.
Epidural abscess
In epidural abscess, profuse, creamy otorrhea is accompanied by steady, throbbing ear pain; a fever; and a temporal or temporoparietal headache on the ipsilateral side.
Myringitis (infectious)
With acute infectious myringitis, small, reddened, blood-filled blebs erupt in the external ear canal, the tympanic membrane and, occasionally, the middle ear. Spontaneous rupture of these blebs causes serosanguineous otorrhea. Other features include severe ear pain, tenderness over the mastoid process and, rarely, a fever and hearing loss.
Chronic infectious myringitis causes purulent otorrhea, pruritus, and gradual hearing loss.
Otitis externa
Acute otitis externa, commonly known as swimmer’s ear, usually causes purulent, yellow, sticky, foul-smelling otorrhea. Inspection may reveal white-green debris in the external ear canal. Associated findings include edema, erythema, pain, and itching of the auricle and external ear canal; severe tenderness with movement of the mastoid, tragus, mouth, or jaw; tenderness and swelling of surrounding nodes; and partial conductive hearing loss. The patient may also develop a low-grade fever and a headache ipsilateral to the affected ear.
Chronic otitis externa usually causes scanty, intermittent otorrhea that may be serous or purulent and possibly foul-smelling. Its primary symptom, however, is itching. Related findings include edema and slight erythema.
Life-threatening malignant otitis externa produces debris in the ear canal, which may build up against the tympanic membrane, causing severe pain that’s especially acute during manipulation of the tragus or auricle. Most common in patients with diabetes and immunosuppressed patients, this fulminant bacterial infection may also cause pruritus, tinnitus and, possibly, unilateral hearing loss.
Otitis media
With acute otitis media, rupture of the tympanic membrane produces bloody, purulent otorrhea and relieves continuous or intermittent ear pain. Typically, a conductive hearing loss worsens over several hours.
With acute suppurative otitis media, the patient may also exhibit signs and symptoms of an upper respiratory infection — a sore throat, a cough, nasal discharge, and a headache. Other features include dizziness, a fever, nausea, and vomiting.
Chronic otitis media causes intermittent, purulent, foul-smelling otorrhea commonly associated with tympanic membrane perforation. Conductive hearing loss occurs gradually and may be accompanied by pain, nausea, and vertigo.
Trauma
Bloody otorrhea may result from trauma, such as a blow to the external ear, a foreign body in the ear, or barotrauma. Usually, bleeding is minimal or moderate; it may be accompanied by partial hearing loss.
Tumor (malignant)
Squamous cell carcinoma of the external ear causes purulent otorrhea with itching; deep, boring ear pain; hearing loss; and, in late stages, facial paralysis.
In squamous cell carcinoma of the middle ear, blood-tinged otorrhea occurs early, typically accompanied by hearing loss on the affected side. Pain and facial paralysis are late features.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Hearing loss:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Congenital hearing loss may be transmitted as a dominant, autosomal dominant, autosomal recessive, or sex-linked recessive trait. Hearing loss in neonates may also result from trauma, toxicity, or infection during pregnancy or delivery. Predisposing factors include a family history of hearing loss or known hereditary disorders (otosclerosis, for example), maternal exposure to rubella or syphilis during pregnancy, use of ototoxic drugs during pregnancy, prolonged fetal anoxia during delivery, and congenital abnormalities of the ears, nose, or throat. Premature or low-birth-weight neonates are most likely to have structural or functional hearing impairment; those with serum bilirubin levels above 20 mg/dl also risk hearing impairment from the toxic effect of high serum bilirubin levels on the brain. In addition, trauma during delivery may cause intracranial hemorrhage and may damage the cochlea or the acoustic nerve.
Sudden deafness refers to sudden hearing loss in a person with no prior hearing impairment. This condition is considered a medical emergency because prompt treatment may restore full hearing. Its causes and predisposing factors may include:
❑ acute infections, especially mumps (most common cause of unilateral sensorineural hearing loss in children), and other bacterial and viral infections, such as rubella, rubeola, influenza, herpes zoster, and infectious mononucleosis; and mycoplasma infections
❑ blood dyscrasias (leukemia, hypercoagulation)
❑ head trauma or brain tumors
❑ metabolic disorders (diabetes mellitus, hypothyroidism, hyperlipoproteinemia)
❑ neurologic disorders (multiple sclerosis, neurosyphilis)
❑ ototoxic drugs (tobramycin, streptomycin, quinine, gentamicin, furosemide, ethacrynic acid)
❑ vascular disorders (hypertension, arteriosclerosis).
Noise-induced hearing loss, which may be transient or permanent, may follow prolonged exposure to loud noise (85 to 90 dB) or brief exposure to extremely loud noise (greater than 90 dB). Such hearing loss is common in workers subjected to constant industrial noise and in military personnel, hunters, and rock musicians.
Presbycusis, an otologic effect of aging, results from a loss of hair cells in the organ of Corti. This disorder causes progressive, symmetrical, bilateral sensorineural hearing loss, usually of high-frequency tones.
Minor decreases in hearing are common after age 20. Some deafness due to nerve damage occurs in one of every five people by age 55.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Hearing loss:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Acoustic neuroma
This eighth cranial nerve tumor causes unilateral, progressive, sensorineural hearing loss. The patient may also develop tinnitus, vertigo, and—with cranial nerve compression—facial paralysis.
Adenoid hypertrophy
Eustachian tube dysfunction gradually causes conductive hearing loss accompanied by intermittent ear discharge. The patient also tends to breathe through his mouth and may complain of a sensation of ear fullness.
Allergies
Conductive hearing loss may result when an allergy produces eustachian tube and middle ear congestion. Other features include ear pain or a feeling of fullness, nasal congestion, and conjunctivitis.
Aural polyps
If a polyp occludes the external auditory canal, partial hearing loss may occur. The polyp typically bleeds easily and is covered by a purulent discharge.
Cholesteatoma
Gradual hearing loss is characteristic in this disorder and may be accompanied by vertigo and, at times, facial paralysis. Examination reveals eardrum perforation, pearly white balls in the ear canal and, possibly, a discharge.
Cyst
Ear canal obstruction by a sebaceous or dermoid cyst causes progressive conductive hearing loss. On inspection, the cyst looks like a soft mass.
External ear canal tumor (malignant)
Progressive conductive hearing loss is characteristic and is accompanied by deep, boring ear pain; a purulent discharge; and eventually facial paralysis. Examination may detect the granular, bleeding tumor.
Furuncle
Reversible conductive hearing loss may occur when one of these painful, hard nodules forms in the ear. The patient may report a sense of fullness in the ear and pain on palpation of the tragus or auricle. Rupture relieves the pain and produces a purulent, necrotic discharge.
Glomus jugulare tumor
Initially, this benign tumor causes mild, unilateral conductive hearing loss that becomes progressively more severe. The patient may report tinnitus that sounds like his heartbeat. Associated signs and symptoms include gradual congestion in the affected ear, throbbing or pulsating discomfort, bloody otorrhea, facial nerve paralysis, and vertigo. Although the tympanic membrane is normal, a reddened mass appears behind it.
Glomus tympanum tumor
This cancerous middle ear tumor causes slowly progressive hearing loss and throbbing or pulsating tinnitus. It usually bleeds easily when manipulated. Late features include ear pain, dizziness, and total unilateral deafness.
Granuloma
A rare cause of conductive hearing loss, a granuloma may also produce fullness in the ear, deep-seated pain, and a bloody discharge.
Head trauma
Sudden conductive or sensorineural hearing loss may result from ossicle disruption, ear canal fracture, tympanic membrane perforation, or cochlear fracture associated with head trauma. Typically, the patient reports a headache and exhibits bleeding from his ear. Neurologic features vary and may include impaired vision and altered level of consciousness.
Herpes zoster oticus (Ramsay Hunt syndrome)
This syndrome causes sudden severe, unilateral mixed hearing loss, which may be accompanied by vesicles in the external ear, tinnitus, vertigo, ear pain, malaise, and transient ipsilateral facial paralysis.
Hypothyroidism
This disorder may produce reversible sensorineural hearing loss. Other effects include bradycardia, weight gain despite anorexia, mental dullness, cold intolerance, facial edema, brittle hair, and dry skin that’s pale, cool, and doughy.
Ménière’s disease
Initially, this inner ear disorder produces intermittent, unilateral sensorineural hearing loss that involves only low tones. Later, hearing loss becomes constant and affects other tones. Associated signs and symptoms include intermittent severe vertigo, nausea and vomiting, a feeling of fullness in the ear, a roaring or hollow-seashell tinnitus, diaphoresis, and nystagmus.
Multiple sclerosis
Rarely, this disorder causes sensorineural hearing loss associated with myelin destruction of the central auditory pathways. The hearing loss may be sudden and unilateral or intermittent and bilateral. Among other characteristics are impaired vision, paresthesia, muscle weakness, gait ataxia, intention tremor, urinary disturbances, and emotional lability.
Myringitis
Rarely, acute infectious myringitis produces conductive hearing loss when fluid accumulates in the middle ear or a large bleb totally obstructs the ear canal. Small, reddened inflamed blebs may develop in the canal, on the tympanic membrane, or in the middle ear and may produce a bloody discharge if they rupture. Associated findings may include severe ear pain, mastoid tenderness, and fever.
Chronic granular myringitis produces gradual hearing loss accompanied by pruritus and a purulent discharge.
Nasopharyngeal cancer
This type of cancer causes mild unilateral conductive hearing loss when it compresses the eustachian tube. Bone conduction is normal, and inspection reveals a retracted tympanic membrane backed by fluid. When this tumor obstructs the nasal airway, the patient may exhibit nasal speech and a bloody nasal and postnasal discharge. Cranial nerve involvement produces other findings, such as diplopia and rectus muscle paralysis.
Osteoma
Commonly affecting women and swimmers, osteoma may cause sudden or intermittent conductive hearing loss. Typically, bony projections are visible in the ear canal, but the tympanic membrane appears normal.
Otitis externa
Conductive hearing loss resulting from debris in the ear canal characterizes both acute and malignant otitis externa. In acute otitis externa, ear canal inflammation produces pain, itching, and a foul-smelling, sticky yellow discharge. Severe tenderness is typically elicited by chewing, opening the mouth, and pressing on the tragus or mastoid. The patient may also develop a low-grade fever, regional lymphadenopathy, a headache on the affected side, and mild to moderate pain around the ear that may later intensify. Examination may reveal greenish white debris or edema in the canal.
In malignant otitis externa, debris is also visible in the canal. This life-threatening disorder, which most commonly occurs in diabetics, causes sensorineural hearing loss, pruritus, tinnitus, and severe ear pain.
Otitis media
This middle ear inflammation typically produces unilateral conductive hearing loss. In acute suppurative otitis media, the hearing loss develops gradually over a few hours and is usually accompanied by an upper respiratory tract infection with sore throat, cough, nasal discharge, and headache. Related signs and symptoms include dizziness, a sensation of fullness in the ear, intermittent or constant ear pain, fever, nausea, and vomiting. Rupture of the bulging, swollen tympanic membrane relieves the pain and produces a brief bloody and purulent discharge. Hearing returns after the infection subsides.
Hearing loss also develops gradually in patients with chronic otitis media. Assessment may reveal a perforated tympanic membrane, purulent ear drainage, earache, nausea, and vertigo.
Commonly associated with an upper respiratory tract infection or nasopharyngeal cancer, serous otitis media commonly produces a stuffy feeling in the ear and pain that worsens at night. Examination reveals a retracted—and perhaps discolored—tympanic membrane and possibly air bubbles behind the membrane.
Otosclerosis
In this hereditary disorder, unilateral conductive hearing loss usually begins when the patient is in his early twenties and may gradually progress to bilateral mixed hearing loss. The patient may report tinnitus and an ability to hear better in a noisy environment.
Gender Cue: Otosclerosis affects twice as many women as men and may worsen during pregnancy.
Skull fracture
Auditory nerve injury causes sudden unilateral sensorineural hearing loss. Accompanying signs and symptoms include ringing tinnitus, blood behind the tympanic membrane, scalp wounds, and other findings.
Syphilis
In tertiary syphilis, sensorineural hearing loss may develop suddenly or gradually and usually affects one ear more than the other. It’s usually accompanied by a gumma lesion—a chronic, superficial nodule or a deep, granulomatous lesion on the skin or mucous membranes. The lesion is solitary, asymmetrical, painless, and indurated. The patient may also exhibit signs of liver, respiratory, cardiovascular, or neurologic dysfunction.
Temporal arteritis
This disorder may produce unilateral sensorineural hearing loss accompanied by throbbing unilateral facial pain, pain behind the eye, temporal or frontotemporal headache, and occasionally vision loss. The hearing loss is usually preceded by a prodrome of malaise, anorexia, weight loss, weakness, and myalgia that lasts for several days. Examination may reveal a nodular, swollen temporal artery. Low-grade fever, confusion, and disorientation may also occur.
Temporal bone fracture
This fracture can cause sudden unilateral sensorineural hearing loss accompanied by hissing tinnitus. The tympanic membrane may be perforated, depending on the fracture’s location. Loss of consciousness, Battle’s sign, and facial paralysis may also occur.
Tuberculosis
This pulmonary infection may spread to the ear, resulting in eardrum perforation, mild conductive hearing loss, and cervical lymphadenopathy.
Tympanic membrane perforation
Commonly caused by trauma from sharp objects or rapid pressure changes, perforation of the tympanic membrane causes abrupt hearing loss along with ear pain, tinnitus, vertigo, and a sensation of fullness in the ear.
Wegener’s granulomatosis
Conductive hearing loss develops slowly in this rare necrotizing, granulomatous vasculitis. This multisystem disorder may also cause cough, pleuritic chest pain, epistaxis, hemorrhagic skin lesions, oliguria, and nasal discharge.
Other causes
Drugs
Ototoxic drugs typically produce ringing or buzzing tinnitus and a feeling of fullness in the ear. Chloroquine, cisplatin, vancomycin, and aminoglycosides (especially neomycin, kanamycin, and amikacin) may cause irreversible hearing loss. Loop diuretics, such as furosemide, ethacrynic acid, and bumetanide, usually produce a brief, reversible hearing loss. Quinine, quinidine, and high doses of erythromycin or salicylates (such as aspirin) may also cause reversible hearing loss.
Radiation therapy
Irradiation of the middle ear, thyroid, face, skull, or nasopharynx may cause eustachian tube dysfunction, resulting in hearing loss.
Surgery
Myringotomy, myringoplasty, simple or radical mastoidectomy, or fenestrations may cause scarring that interferes with hearing.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Otorrhea:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Allergy
An allergy associated with tympanic membrane perforation may cause clear or cloudy otorrhea, rhinorrhea, and itchy, watery eyes.
Aural polyps
These polyps may produce foul, purulent, and perhaps blood-streaked discharge. If they occlude the external ear canal, the polyps may cause partial hearing loss.
Basilar skull fracture
With this disorder, otorrhea may be clear and watery and positive for glucose representing cerebrospinal fluid (CSF) leakage, or bloody, representing hemorrhage. Occasionally, inspection reveals blood behind the eardrum. The otorrhea may be accompanied by hearing loss, CSF or bloody rhinorrhea, periorbital ecchymosis (raccoon eyes), and mastoid ecchymosis (Battle’s sign). Cranial nerve palsies, decreased level of consciousness, and headache are other common findings.
Dermatitis of the external ear canal
With contact dermatitis, vesicles produce clear, watery otorrhea with edema and erythema of the external ear canal.
Infectious eczematoid dermatitis causes purulent otorrhea with erythema and crusting of the external ear canal.
With seborrheic dermatitis, otorrhea consists of greasy scales and flakes. The scalp, forehead, and cheeks are also marked by pruritic, scaly lesions.
Epidural abscess
In this disorder, profuse, creamy otorrhea is accompanied by steady, throbbing ear pain; fever; and temporal or temporoparietal headache on the ipsilateral side.
Mastoiditis
This disorder causes thick, purulent, yellow otorrhea that becomes increasingly profuse. Its cardinal features include low-grade fever and dull aching and tenderness in the mastoid area. Postauricular erythema and edema may push the auricle out from the head; pressure within the edematous mastoid antrum may produce swelling and obstruction of the external ear canal, causing conductive hearing loss.
Myringitis (infectious)
With acute infectious myringitis, small, reddened, blood-filled blebs erupt in the external ear canal, the tympanic membrane, and occasionally, the middle ear. Spontaneous rupture of these blebs causes serosanguineous otorrhea. Other features include severe ear pain, tenderness over the mastoid process, and rarely, fever and hearing loss.
Chronic infectious myringitis causes purulent otorrhea, pruritus, and gradual hearing loss.
Otitis externa
Acute otitis externa, commonly known as swimmer’s ear, usually causes purulent, yellow, sticky, foul-smelling otorrhea. Inspection may reveal white-green debris in the external ear canal. Associated findings include edema, erythema, pain, and itching of the auricle and external ear canal; severe tenderness with movement of the mastoid, tragus, mouth, or jaw; tenderness and swelling of surrounding nodes; and partial conductive hearing loss. The patient may also develop a low-grade fever and a headache ipsilateral to the affected ear.
Chronic otitis externa usually causes scanty, intermittent otorrhea that may be serous or purulent and possibly foul-smelling. Its primary symptom, though, is itching. Related findings include edema and slight erythema.
Life-threatening malignant otitis externa produces debris in the ear canal, which may build up against the tympanic membrane, causing severe pain that’s especially acute during manipulation of the tragus or auricle. Most common in diabetics and immunosuppressed patients, this fulminant bacterial infection may also cause pruritus, tinnitus and, possibly, unilateral hearing loss.
Otitis media
With acute otitis media, rupture of the tympanic membrane produces bloody, purulent otorrhea and relieves continuous or intermittent ear pain. Typically, a conductive hearing loss worsens over several hours.
With acute suppurative otitis media, the patient may also exhibit signs and symptoms of upper respiratory infection—sore throat, cough, nasal discharge, and headache. Other features include dizziness, fever, nausea, and vomiting.
Chronic otitis media causes intermittent, purulent, foul-smelling otorrhea commonly associated with perforation of the tympanic membrane. Conductive hearing loss occurs gradually and may be accompanied by pain, nausea, and vertigo.
Perichondritis
In this disorder, multiple fistulas may open on the auricle or external ear canal, causing purulent otorrhea. Typically, the auricle is edematous and erythematous, with thickened skin.
Trauma
Bloody otorrhea may result from trauma, such as a blow to the external ear, a foreign body in the ear, or barotrauma. Usually, the bleeding is minimal or moderate; it may be accompanied by partial hearing loss.
Tuberculosis
Pulmonary tuberculosis may spread through the upper airway to the middle ear, causing chronic ear infection. The tympanic membrane thickens, ruptures, and produces a watery otorrhea and mild hearing loss. Cervical adenopathy may also occur.
Tumor (benign)
A benign tumor of the glomus jugulare (jugular bulb) may cause bloody otorrhea. Initially, the patient may complain of throbbing discomfort and tinnitus that resembles the sound of his heartbeat. Associated signs and symptoms include gradually progressive stuffiness in the affected ear, vertigo, conductive hearing loss and, possibly, a reddened mass behind the tympanic membrane.
Tumor (malignant)
Squamous cell carcinoma of the external ear causes purulent otorrhea with itching; deep, boring ear pain; hearing loss; and, in late stages, facial paralysis.
In squamous cell carcinoma of the middle ear, blood-tinged otorrhea occurs early, typically accompanied by hearing loss on the affected side. Pain and facial paralysis are late features.
Wegener’s granulomatosis
This rare, necrotizing granulomatous vasculitis commonly causes perforation of the tympanic membrane and serosanguineous otorrhea. The patient may report a slowly progressive hearing loss, a cough (possibly hemoptysis), wheezing, shortness of breath, pleuritic chest pain, hemorrhagic skin lesions, epistaxis, and signs of severe sinusitis.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Earache [Otalgia]:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Abscess (extradural)
Severe earache accompanied by a persistent ipsilateral headache, malaise, and recurrent mild fever characterizes this serious complication of middle ear infection.
Barotrauma (acute)
Earache associated with barotrauma ranges from mild pressure to severe pain. Tympanic membrane ecchymosis or bleeding into the tympanic cavity may occur, producing a blue drumhead; the eardrum usually isn’t perforated.
Cerumen impaction
Impacted cerumen (earwax) may cause a sensation of blockage or fullness in the ear. Additional features include partial hearing loss, itching and, possibly, dizziness.
Chondrodermatitis nodularis chronica
Chondrodermatitis nodularis chronica produces small, painful, indurated areas along the auricle’s upper rim.
Ear canal obstruction by an insect
An insect lodged in the ear canal may cause severe pain and distressing noise.
Frostbite
Prolonged exposure to cold may cause burning or tingling pain in the ear, followed by numbness. The ear appears mottled and gray or white; it turns purplish blue as it’s warmed.
Furunculosis
Infected hair follicles in the outer ear canal may produce severe, localized ear pain associated with a pus-filled furuncle (boil). The pain is aggravated by jaw movement and relieved by rupture or incision of the furuncle. Pinna tenderness, swelling of the auditory meatus, partial hearing loss, and a feeling of fullness in the ear canal may also occur.
Herpes zoster oticus (Ramsay Hunt syndrome)
Herpes zoster oticus causes burning or stabbing ear pain that’s commonly associated with ear vesicles. The patient also complains of hearing loss and vertigo. Associated signs and symptoms include transient ipsilateral facial paralysis, partial loss of taste, tongue vesicles, and nausea and vomiting.
Keratosis obturans
Mild ear pain, otorrhea, and tinnitus are common in keratosis obturans. Inspection reveals a white glistening plug obstructing the external meatus.
Mastoiditis (acute)
Mastoiditis causes a dull ache behind the ear accompanied by low-grade fever (99° F to 100° F [37.2° C to 37.8° C]). The eardrum appears dull and edematous and may perforate, and soft tissue near the eardrum may sag. A purulent discharge is seen in the external canal.
Ménière’s disease
Ménière’s disease is an inner ear disorder that can produce a sensation of fullness in the affected ear. Its classic effects, however, include severe vertigo, tinnitus, and sensorineural hearing loss. The patient may also experience nausea and vomiting, diaphoresis, and nystagmus.
Middle ear tumor
Deep, boring ear pain and facial paralysis are late signs of a malignant tumor.
Myringitis bullosa
Myringitis bullosa is a rare bacterial infection that causes sudden, severe ear pain that radiates over the mastoid and lasts for up to 48 hours. Small serous or blood-filled vesicles may dot the reddened tympanic membrane. Transient hearing loss and a serosanguineous discharge may also occur.
Otitis externa
Earache characterizes both acute and malignant otitis externa. Acute otitis externa begins with mild to moderate ear pain that occurs with tragus manipulation. The pain may be accompanied by low-grade fever, sticky yellow or purulent ear discharge, partial hearing loss, and a feeling of blockage. Later, ear pain intensifies, causing the entire side of the head to ache and throb. Fever may reach 104° F (40° C). Examination reveals swelling of the tragus, external meatus, and external canal; eardrum erythema; and lymphadenopathy. The patient also complains of dizziness and malaise.
Malignant otitis externa causes sudden ear pain that’s aggravated by moving the auricle or tragus. The pain is accompanied by intense itching, purulent ear discharge, fever, parotid gland swelling, and trismus. Examination reveals a swollen external canal with exposed cartilage and temporal bone. Cranial nerve palsy may occur.
Otitis media (acute)
Otitis media is a middle ear inflammation that can be serous or suppurative. Acute serous otitis media may cause a feeling of fullness in the ear, hearing loss, and a vague sensation of top-heaviness. The eardrum may be slightly retracted, amber colored, and marked by air bubbles and a meniscus, or it may be blue-black from hemorrhage.
Acute suppurative otitis media is characterized by severe deep, throbbing ear pain; hearing loss; and fever that may reach 102° F (38.9° C).The pain increases steadily over several hours or days and may be aggravated by pressure on the mastoid antrum. Perforation of the eardrum is possible. Before rupture, the eardrum appears bulging and fiery red. Rupture causes purulent drainage and relieves the pain.
Chronic otitis media usually isn’t painful except during exacerbations. Persistent pain and discharge from the ear suggest cancer or osteomyelitis of the skull base.
Perichondritis
Perichondritis can cause ear pain accompanied by warmth and tenderness in the outer ear and a reddened, doughlike auricle.
Petrositis
The result of acute otitis media, this infection produces deep ear pain with headache and pain behind the eye. Other findings are diplopia, loss of lateral gaze, vomiting, sensorineural hearing loss, vertigo and, possibly, nuchal rigidity.
Temporomandibular joint infection
Typically unilateral, temporomandibular joint infection produces ear pain that’s referred from the jaw joint. The pain is aggravated by pressure on the joint with jaw movement; it commonly radiates to the temporal area or the entire side of the head.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Hearing Loss:
Differential Overview
(Field Guide to Bedside Diagnosis)
Sensorineural
❑ Presbyacusis
❑ Noise-induced loss
❑ Drugs
❑ Ménière disease
❑ Eighth nerve injury
❑ Acoustic neuroma
❑ Multiple sclerosis
Conductive
❑ Impacted cerumen
❑ Otitis media
❑ Middle ear effusion
❑ Perforation of tympanic membrane
❑ Otosclerosis
❑ Exostoses
❑ Developmental defect
❑ Glomus tumor
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Source: Field Guide to Bedside Diagnosis, 2007
Ear Pain/Discharge:
Differential Overview
(Field Guide to Bedside Diagnosis)
Ear Pain
❑ Acute otitis media
❑ Acute otitis externa
❑ Eustachian dysfunction
❑ Temporomandibular joint arthritis
❑ Traumatic tympanic membrane rupture
❑ Foreign body, external auditory canal
❑ Erysipelas
❑ Herpes zoster oticus
❑ Dental abscess
❑ Frostbite
❑ Relapsing polychondritis
❑ Malignant otitis externa
❑ Acute mastoiditis
❑ Nasopharyngeal cancer
Ear Discharge
❑ Otitis externa
❑ Eczematoid dermatitis
❑ Low-viscosity cerumen
❑ Otitis media with perforation
❑ Foreign body
❑ Psoriasis
❑ Herpes zoster oticus
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Source: Field Guide to Bedside Diagnosis, 2007
Hearing loss:
Causes
(Handbook of Diseases)
Hearing loss may be congenital, or it may be caused by drugs, illness, loud noise, or aging.
Congenital hearing loss
Hearing loss may be transmitted as a dominant, autosomal dominant, autosomal recessive, or sex-linked recessive trait. In neonates, it may also result from trauma, toxicity, or infection during pregnancy or delivery.
Predisposing factors include a family history of hearing loss or known hereditary disorders (such as otosclerosis), maternal exposure to rubella or syphilis during pregnancy, use of ototoxic drugs during pregnancy, prolonged fetal anoxia during delivery, and congenital abnormalities of the ears, nose, or throat.
Premature or low-birth-weight infants are most likely to have structural or functional hearing impairments; those with serum bilirubin levels greater than 20 mg/dl also risk hearing impairment from the toxic effect of high serum bilirubin levels on the brain.
In addition, trauma during delivery may cause intracranial hemorrhage and damage the cochlea or acoustic nerve.
Sudden hearing loss
Sudden hearing loss may occur in a person with no prior hearing impairment. This condition is considered a medical emergency because prompt treatment may restore full hearing. Its causes and predisposing factors may include:
❑ acute infections, especially mumps (the most common cause of unilateral sensorineural hearing loss in children) and other bacterial and viral infections, such as rubella, rubeola, influenza, herpes zoster, and infectious mononucleosis, and mycoplasmal infections
❑ metabolic disorders, such as diabetes mellitus, hypothyroidism, and hyperlipoproteinemia
❑ vascular disorders, such as hypertension and arteriosclerosis
❑ head trauma or brain tumors
❑ ototoxic drugs, such as tobramycin, streptomycin, quinine, gentamicin, furosemide, and ethacrynic acid
❑ neurologic disorders, such as multiple sclerosis and neurosyphilis
❑ blood dyscrasias, such as leukemia and hypercoagulation.
Noise-induced hearing loss
Noise-induced hearing loss is caused by a loud noise and may be transient or permanent, and may follow prolonged exposure to loud noise (85 to 90 dB) or brief exposure to extremely loud noise (greater than 90 dB). Such hearing loss is common in workers subjected to constant industrial noise and in military personnel, hunters, and rock musicians.
Presbycusis
An otologic effect of aging, presbycusis results from a loss of hair cells in the organ of Corti. This disorder causes sensorineural hearing loss, usually of high-frequency tones.
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Source: Handbook of Diseases, 2003
Earache:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Abscess (extradural)
Severe earache accompanied by persistent ipsilateral headache, malaise, and recurrent mild fever characterizes extradural abscess, a serious complication of middle ear infection. The patient may also experience hearing loss.
Barotrauma (acute)
Earache associated with acute barotrauma ranges from mild pressure to severe pain. Tympanic membrane ecchymosis or bleeding into the tympanic cavity may occur, producing a blue drumhead; the eardrum usually isn’t perforated.
Cerumen impaction
Impacted cerumen (earwax) may cause a sensation of blockage or fullness in the ear. Additional features include partial hearing loss, itching and, possibly, dizziness and ringing in the ear.
Chondrodermatitis nodularis chronica
Chondrodermatitis nodularis chronica produces small, painful, indurated areas along the upper rim of the auricle. The lesion may have a central core with scaly discharge.
Frostbite
Prolonged exposure to cold may cause burning or tingling pain in the ear, followed by numbness. The ear appears mottled and gray or white; it turns purplish blue as it’s warmed.
Furunculosis
Infected hair follicles in the outer ear canal may produce severe, localized ear pain associated with a pus-filled furuncle (boil). The pain is aggravated by jaw movement and relieved by rupture or incision of the furuncle. Pinna tenderness, swelling of the auditory meatus, partial hearing loss, and a feeling of fullness in the ear canal may also occur.
Herpes zoster oticus
Also known as Ramsay Hunt syndrome, herpes zoster oticus causes burning or stabbing ear pain, commonly associated with ear vesicles. The patient also complains of hearing loss and vertigo. Associated signs and symptoms include transitory, ipsilateral, facial paralysis; partial loss of taste; tongue vesicles; and nausea and vomiting.
Mastoiditis (acute)
Acute mastoiditis causes a dull ache behind the ear accompanied by low-grade fever (99° F to 100° F [37.2° C to 37.8° C]). The eardrum appears dull and edematous and may perforate, and soft tissue near the eardrum may sag. A purulent discharge is seen in the external canal.
Ménière’s disease
Ménière’s disease is an inner ear disorder that can produce a sensation of fullness in the affected ear. Its classic effects, however, include severe vertigo, tinnitus, and sensorineural hearing loss. The patient may also experience nausea and vomiting, diaphoresis, and nystagmus.
Middle ear tumor
Deep, boring ear pain and facial paralysis are late signs of a malignant tumor. Hearing loss and facial nerve dysfunction may accompany middle ear tumors.
Otitis externa (acute)
Acute otitis externa begins with mild to moderate ear pain that occurs with tragus manipulation. The pain may be accompanied by low-grade fever, sticky yellow or purulent ear discharge, partial hearing loss, and a feeling of blockage. Later, ear pain intensifies, causing the entire side of the head to ache and throb. Fever may reach 104°F [40° C]. Examination reveals swelling of the tragus, external meatus, and external canal; eardrum erythema; and lymphadenopathy. The patient also complains of dizziness and malaise.
Otitis media (acute)
Acute otitis media is a middle ear inflammation that may be serous or suppurative. Acute serous otitis media may cause a feeling of fullness in the ear, hearing loss, and a vague sensation of top-heaviness. The eardrum may be slightly retracted, amber colored, and marked by air bubbles and a meniscus, or it may be blue-black from hemorrhage.
Severe, deep, throbbing ear pain, hearing loss, and fever that can reach 102°F (38.9° C) characterize acute suppurative otitis media.The pain increases steadily over several hours or days and may be aggravated by pressure on the mastoid antrum. Perforation of the eardrum is possible. Before rupture, the eardrum appears bulging and fiery red. Rupture causes purulent drainage and relieves the pain.
Petrositis
The result of acute otitis media, petrositis is an infection that produces deep ear pain with headache and pain behind the eye. Other findings include diplopia, loss of lateral gaze, vomiting, sensorineural hearing loss, vertigo and, possibly, nuchal rigidity.
Temporomandibular joint infection
Typically unilateral, temporomandibular joint (TMJ) infection produces ear pain that’s referred from the jaw joint. The pain is aggravated by pressure on the joint with jaw movement; it commonly radiates to the temporal area or the entire side of the head.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Hearing loss:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Acoustic neuroma
An acoustic neuroma is an eighth cranial nerve tumor that causes unilateral, progressive, sensorineural hearing loss. The patient may also develop tinnitus, vertigo and, with cranial nerve compression, facial paralysis.
Adenoid hypertrophy
With adenoid hypertrophy, eustachian tube dysfunction gradually causes conductive hearing loss accompanied by intermittent ear discharge. The patient also tends to breathe through his mouth and may complain of a sensation of ear fullness.
Allergies
Conductive hearing loss may result when an allergy produces eustachian tube and middle ear congestion. Other features include ear pain or a feeling of fullness, nasal congestion, and conjunctivitis.
Cholesteatoma
Gradual hearing loss is characteristic in cholesteatoma. It can be accompanied by vertigo and, at times, facial paralysis. Examination reveals eardrum perforation, pearly white balls in the ear canal and, possibly, a discharge.
External ear canal tumor (malignant)
Progressive conductive hearing loss is characteristic of a malignant external ear canal tumor and is accompanied by deep, boring ear pain; purulent discharge; and eventually facial paralysis. Examination may detect the granular, bleeding tumor.
Furuncle
Reversible conductive hearing loss may occur when a furuncle (a painful, hard nodule) forms in the ear. The patient with a furuncle may report a sense of fullness in the ear and pain on palpation of the tragus or auricle. Boil rupture relieves the pain and produces a purulent, necrotic discharge.
Glomus jugulare tumor
Initially, glomus jugulare (a benign tumor) causes mild, unilateral conductive hearing loss that becomes progressively more severe. The patient may report tinnitus that sounds like his heartbeat. Associated signs and symptoms include gradual congestion in the affected ear, throbbing or pulsating discomfort, bloody otorrhea, facial nerve paralysis, and vertigo. Although the tympanic membrane is normal, a reddened mass appears behind it.
Head trauma
Sudden conductive or sensorineural hearing loss may result from ossicle disruption, ear canal fracture, tympanic membrane perforation, or cochlear fracture associated with head trauma. Typically, the patient reports a headache and exhibits bleeding from his ear. Neurologic features vary and may include impaired vision and altered level of consciousness.
Hypothyroidism
Hypothyroidism may produce reversible sensorineural hearing loss. Other effects include bradycardia, weight gain despite anorexia, mental dullness, cold intolerance, facial edema, brittle hair, and dry skin that’s pale, cool, and doughy.
Ménière’s disease
Initially, Ménière’s disease produces intermittent, unilateral sensorineural hearing loss that involves only low tones. Later in this inner ear disorder, hearing loss becomes constant and affects other tones. Associated signs and symptoms of Ménière’s disease include intermittent severe vertigo, nausea and vomiting, a feeling of fullness in the ear, a roaring or hollow-seashell tinnitus, diaphoresis, and nystagmus.
Osteoma
Commonly affecting women and swimmers, osteoma may cause sudden or intermittent conductive hearing loss. Typically, bony projections are visible in the ear canal, but the tympanic membrane appears normal.
Otitis externa
Conductive hearing loss resulting from debris in the ear canal characterizes both acute and malignant otitis externa. With acute otitis externa, ear canal inflammation produces pain, itching, and a foul-smelling, sticky yellow discharge. Severe tenderness is typically elicited by chewing, opening the mouth, and pressing on the tragus or mastoid. The patient may also develop a low-grade fever, regional lymphadenopathy, headache on the affected side, and mild-to-moderate pain around the ear that may later intensify. Examination may reveal greenish white debris or edema in the canal.
With malignant otitis externa, debris is also visible in the canal. This life-threatening disorder, which most commonly occurs in diabetics, causes sensorineural hearing loss, pruritus, tinnitus, and severe ear pain.
Otitis media
Otitis media is a middle ear inflammation that typically produces unilateral conductive hearing loss. In patients with acute suppurative otitis media, the hearing loss develops gradually over a few hours and is usually accompanied by an upper respiratory tract infection with sore throat, cough, nasal discharge, and headache. Related signs and symptoms include dizziness, a sensation of fullness in the ear, intermittent or constant ear pain, fever, nausea, and vomiting. Rupture of the bulging, swollen tympanic membrane relieves the pain and produces a brief, bloody, purulent discharge. Hearing returns after the infection subsides.
Hearing loss also develops gradually in patients with chronic otitis media. Assessment may reveal a perforated tympanic membrane, purulent ear drainage, earache, nausea, and vertigo.
Commonly associated with an upper respiratory tract infection or nasopharyngeal cancer, serous otitis media commonly produces a stuffy feeling in the ear and pain that worsens at night. Examination reveals a retracted — and perhaps discolored — tympanic membrane and, possibly, air bubbles behind the membrane.
Otosclerosis
In otosclerosis, a hereditary disorder, unilateral conductive hearing loss usually begins when the patient is in his early 20s and may gradually progress to bilateral mixed loss. The patient may report tinnitus and an ability to hear better in a noisy environment. The deafness is usually noticed between ages 11 and 30.
Skull fracture
Auditory nerve injury from a skull fracture causes sudden unilateral sensorineural hearing loss. Accompanying signs and symptoms include ringing tinnitus, blood behind the tympanic membrane, scalp wounds, and other findings.
Temporal arteritis
Temporal arteritis may produce unilateral sensorineural hearing loss accompanied by throbbing unilateral facial pain, pain behind the eye, temporal or frontotemporal headache and, occasionally, vision loss. The hearing loss is usually preceded by a prodrome of malaise, anorexia, weight loss, weakness, and myalgia that lasts for several days. Examination may reveal a nodular, swollen temporal artery. Low-grade fever, confusion, and disorientation may also occur.
Temporal bone fracture
Temporal bone fracture can cause sudden unilateral sensorineural hearing loss accompanied by hissing tinnitus. The tympanic membrane may be perforated, depending on the fracture’s location. Loss of consciousness, Battle’s sign, and facial paralysis may also occur.
Tuberculosis
Tuberculosis, a pulmonary infection, may spread to the ear, resulting in eardrum perforation, mild conductive hearing loss, and cervical lymphadenopathy. Other signs and symptoms include chest pain, crackles, dyspnea, fatigue, fever, and tachypnea.
Tympanic membrane perforation
Commonly caused by trauma from sharp objects or rapid pressure changes, perforation of the tympanic membrane causes abrupt hearing loss along with ear pain, tinnitus, vertigo, and a sensation of fullness in the ear.
Other causes
Drugs
Ototoxic drugs typically produce ringing or buzzing tinnitus and a feeling of fullness in the ear. Chloroquine, cisplatin, vancomycin, and aminoglycosides (especially neomycin, kanamycin, and amikacin) may cause irreversible hearing loss. Loop diuretics, such as furosemide, ethacrynic acid, and bumetanide, usually produce a brief, reversible hearing loss. Quinine, quinidine, and high doses of erythromycin or salicylates (such as aspirin) may also cause reversible hearing loss.
Radiation therapy
Irradiation of the middle ear, thyroid, face, skull, or nasopharynx may cause eustachian tube dysfunction, resulting in hearing loss.
Surgery
Myringotomy, myringoplasty, simple or radical mastoidectomy, or fenestrations may cause scarring that interferes with hearing.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Otorrhea:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Allergy
An allergy associated with tympanic membrane perforation may cause clear or cloudy otorrhea, rhinorrhea, and itchy, watery eyes. The patient may also report nasal congestion and an itchy nose and throat.
Aural polyps
Aural polyps may produce foul, purulent, and perhaps blood-streaked discharge. If they occlude the external ear canal, the polyps may cause partial hearing loss.
Basilar skull fracture
With a basilar skull fracture, otorrhea may be clear and watery and positive for glucose, representing cerebrospinal fluid (CSF) leakage, or bloody, representing hemorrhage. Occasionally, inspection reveals blood behind the eardrum. The otorrhea may be accompanied by hearing loss, CSF or bloody rhinorrhea, periorbital ecchymosis (raccoon eyes), and mastoid ecchymosis (Battle’s sign). Cranial nerve palsies, decreased level of consciousness, and headache are other common findings.
Dermatitis of the external ear canal
With contact dermatitis, vesicles produce clear, watery otorrhea with edema and erythema of the external ear canal.
Infectious eczematoid dermatitis causes purulent otorrhea with erythema and crusting of the external ear canal.
With seborrheic dermatitis, otorrhea consists of greasy scales and flakes. The scalp, forehead, and cheeks are also marked by pruritic, scaly lesions.
Mastoiditis
Mastoiditis causes thick, purulent, yellow otorrhea that becomes increasingly profuse. Its cardinal features include low-grade fever and dull aching and tenderness in the mastoid area. Postauricular erythema and edema may push the auricle out from the head; pressure within the edematous mastoid antrum may produce swelling and obstruction of the external ear canal, causing conductive hearing loss.
Myringitis (infectious)
With acute infectious myringitis, small, reddened, blood-filled blebs erupt in the external ear canal, the tympanic membrane and, occasionally, the middle ear. Spontaneous rupture of these blebs causes serosanguineous otorrhea. Other features include severe ear pain, tenderness over the mastoid process and, rarely, fever and hearing loss.
Chronic infectious myringitis causes purulent otorrhea, pruritus, and gradual hearing loss.
Otitis externa
Acute otitis externa, commonly known as swimmer’s ear, usually causes purulent, yellow, sticky, foul-smelling otorrhea. Inspection may reveal white-green debris in the external ear canal. Associated findings include edema, erythema, pain, and itching of the auricle and external ear canal; severe tenderness with movement of the mastoid, tragus, mouth, or jaw; tenderness and swelling of surrounding nodes; and partial conductive hearing loss. The patient may also develop a low-grade fever and a headache ipsilateral to the affected ear.
Chronic otitis externa usually causes scanty, intermittent otorrhea that may be serous or purulent and possibly foul-smelling. Its primary symptom, however, is itching. Related findings include edema and slight erythema.
Otitis media
With acute otitis media, rupture of the tympanic membrane produces bloody, purulent otorrhea and relieves continuous or intermittent ear pain. Typically, a conductive hearing loss worsens over several hours.
With acute suppurative otitis media, the patient may also exhibit signs and symptoms of upper respiratory infection — sore throat, cough, nasal discharge, and headache. Other features include dizziness, fever, nausea, and vomiting.
Chronic otitis media causes intermittent, purulent, foul-smelling otorrhea commonly associated with perforation of the tympanic membrane. Conductive hearing loss occurs gradually and may be accompanied by pain, nausea, and vertigo.
Trauma
Bloody otorrhea may result from trauma, such as a blow to the external ear, a foreign body in the ear, or barotrauma. Usually, the bleeding is minimal or moderate; it may be accompanied by partial hearing loss.
Tumor
A benign tumor of the glomus jugulare (jugular bulb) may cause bloody otorrhea. Initially, the patient may complain of throbbing discomfort and tinnitus that resembles the sound of his heartbeat. Associated signs and symptoms include gradually progressive stuffiness in the affected ear, vertigo, conductive hearing loss and, possibly, a reddened mass behind the tympanic membrane.
Squamous cell carcinoma of the external ear (a malignant tumor) causes purulent otorrhea with itching; deep, boring ear pain; hearing loss; and, in late stages, facial paralysis.
In squamous cell carcinoma of the middle ear, blood-tinged otorrhea occurs early, typically accompanied by hearing loss on the affected side. Pain and facial paralysis are late features.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Earache:
Principal Causes of Earache
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Externalear including external auditory canal
- Infection/inflammation
- Otitisexterna
- Cellulitis
- Furuncle or abscess
- Perichondritis of the pinna
- Cerumen impaction
- Trauma
- Foreign body
- Neoplasm
- Middle ear, eustachian tube, and mastoiddisorders
- Infection/inflammation
- Acuteand chronic otitis media
- Otitis media with effusion
- Mastoiditis
- Trauma
- Neoplasm
- Referred ear pain from cranial nerves(V, VII, IX, X) or cervical nerves (C2, C3)
- Cranialnerve V
- Cranial nerve VII
- Cranial nerve IX
- Cranial nerve X
- Cervical nerves (C2 and C3)
- Psychogenic
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Hearing Loss and Deafness:
Principal Causes of Hearing Loss and Deafness
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Conductivehearing loss
- Externalauditory canal disorders
- Atresia of external auditory canal
- Impacted cerumen
- Otitis externa
- Exostosis
- Masses
- Middle ear disorders
- Acuteand chronic otitis media
- Otitis media with effusion
- Tympanic membrane perforation
- Hemotympanum
- Tympanosclerosis
- Ossicular chain defect, disruption,or fixation
- Cholesteatoma and other middle earmasses
- Sensorineural hearing loss
- Sensorineuralhearing loss without associated abnormalities
- Sensorineural hearing loss with associatedabnormalities
- Chromosomal disorders
- Inner ear malformations
- Labyrinthineaplasia
- Common cavity malformation
- Cochlear malformations
- Large vestibular aqueduct
- Prematurity
- Hypoxic-ischemic encephalopathy
- Bilirubin encephalopathy (kernicterus)
- Infection
- Trauma
- Drugs
- Perilymph fistula
- Neoplasm
- Ménière disease
- Unknown
- Mixed hearing loss
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Hearing loss:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Acoustic neuroma.Acoustic neuroma, which is a CN VIII tumor, causes unilateral, progressive, sensorineural hearing loss. The patient may also develop tinnitus, vertigo, and—with cranial nerve compression—facial paralysis.
Adenoid hypertrophy.Eustachian tube dysfunction causes gradual conductive hearing loss accompanied by intermittent ear discharge. The patient also tends to breathe through his mouth and may complain of a sensation of ear fullness.
Aural polyps.If a polyp occludes the external auditory canal, partial hearing loss may occur. The polyp typically bleeds easily and is covered by a purulent discharge.
Cholesteatoma.Gradual hearing loss is characteristic of cholesteatoma. It can be accompanied by vertigo and, at times, facial paralysis. Examination reveals eardrum perforation, pearly white balls in the ear canal, and possible discharge.
Cyst.Ear canal obstruction by a sebaceous or dermoid cyst causes progressive conductive hearing loss. On inspection, the cyst looks like a soft mass.
External ear canal tumor (malignant).Progressive conductive hearing loss is characteristic of an external ear canal tumor and is accompanied by deep, boring ear pain, purulent discharge and, eventually, facial paralysis. The patient may develop a rash in the external canal or pinna of the ear. Examination may detect the granular, bleeding tumor.
Glomus jugulare tumor.Initially, this benign tumor causes mild, unilateral conductive hearing loss that becomes progressively more severe. The patient may report tinnitus that sounds like his heartbeat. Associated signs and symptoms include gradual congestion in the affected ear, throbbing or pulsating discomfort, bloody otorrhea, facial nerve paralysis, and vertigo. Although the tympanic membrane is normal, a reddened mass appears behind it.
Head trauma.Sudden conductive or sensorineural hearing loss may result from ossicle disruption, ear canal fracture, tympanic membrane perforation, or cochlear fracture associated with head trauma. Typically, the patient reports a headache and exhibits bleeding from his ear. Neurologic features vary and may include impaired vision and an altered level of consciousness.
Ménière's disease.Initially, Ménière's disease, an inner ear disorder, produces intermittent, unilateral sensorineural hearing loss that involves only low tones. Later, hearing loss becomes constant and affects other tones. Associated signs and symptoms include intermittent severe vertigo, nausea and vomiting, a feeling of fullness in the ear, a roaring or hollow-seashell tinnitus, diaphoresis, and nystagmus.
Nasopharyngeal cancer.Nasopharyngeal cancer causes mild unilateral conductive hearing loss when it compresses the eustachian tube. Bone conduction is normal, and inspection reveals a retracted tympanic membrane backed by fluid. When this tumor obstructs the nasal airway, the patient may exhibit nasal speech and a bloody nasal and postnasal discharge. Cranial nerve involvement produces other findings, such as diplopia and rectus muscle paralysis.
Otitis externa.Conductive hearing loss resulting from debris in the ear canal characterizes acute and malignant otitis externa. With acute otitis externa, ear canal inflammation produces pain, itching, and a foul-smelling, sticky yellow discharge. Severe tenderness is typically elicited by chewing, opening the mouth, and pressing on the tragus or mastoid. The patient may also develop a low-grade fever, regional lymphadenopathy, a headache on the affected side, and mild to moderate pain around the ear that may later intensify. Examination may reveal greenish white debris or edema in the canal.
With malignant otitis externa, debris is also visible in the canal. This life-threatening disorder, which most commonly occurs in the patient with diabetes, causes sensorineural hearing loss, pruritus, tinnitus, and severe ear pain.
Otitis media.Otitis media is a middle ear inflammation that typically produces unilateral conductive hearing loss. In patients with acute suppurative otitis media, the hearing loss develops gradually over a few hours and is usually accompanied by an upper respiratory tract infection with a sore throat, cough, nasal discharge, and headache. Related signs and symptoms include dizziness, a sensation of fullness in the ear, intermittent or constant ear pain, a fever, nausea, and vomiting. Rupture of the bulging, swollen tympanic membrane relieves the pain and produces a brief, bloody, purulent discharge. Hearing returns after the infection subsides.
Hearing loss also develops gradually in patients with chronic otitis media. Assessment may reveal a perforated tympanic membrane, purulent ear drainage, an earache, nausea, and vertigo.
Commonly associated with an upper respiratory tract infection or nasopharyngeal cancer, serous otitis media commonly produces a stuffy feeling in the ear and pain that worsens at night. Examination reveals a retracted—and perhaps discolored—tympanic membrane and possibly air bubbles behind the membrane.
Otosclerosis.Otosclerosis is a hereditary disorder in which unilateral conductive hearing loss usually begins when the patient is in his early twenties and may gradually progress to bilateral mixed loss. The patient may report tinnitus and an ability to hear better in a noisy environment. The deafness is usually noticed between ages 11 and 30.
Skull fracture.With a skull fracture, auditory nerve injury causes sudden unilateral sensorineural hearing loss. Accompanying signs and symptoms include ringing tinnitus, blood behind the tympanic membrane, scalp wounds, and other findings.
Temporal bone fracture.Temporal bone fracture can cause sudden unilateral sensorineural hearing loss accompanied by hissing tinnitus. The tympanic membrane may be perforated, depending on the fracture's location. Loss of consciousness, Battle's sign, and facial paralysis may also occur.
Tympanic membrane perforation.Commonly caused by trauma from sharp objects or rapid pressure changes, perforation of the tympanic membrane causes abrupt hearing loss along with ear pain, tinnitus, vertigo, and a sensation of fullness in the ear.
Other causes
Drugs.Ototoxic drugs typically produce ringing or buzzing tinnitus and a feeling of fullness in the ear. Chloroquine, cisplatin, vancomycin, and aminoglycosides (especially neomycin, kanamycin, and amikacin) may cause irreversible hearing loss. Loop diuretics, such as furosemide, ethacrynic acid, and bumetanide, usually produce a brief, reversible hearing loss. Quinine, quinidine, and high doses of erythromycin or salicylates (such as aspirin) may also cause reversible hearing loss.
Radiation therapy.Irradiation of the middle ear, thyroid, face, skull, or nasopharynx may cause eustachian tube dysfunction, resulting in hearing loss.
Surgery.Myringotomy, myringoplasty, simple or radical mastoidectomy, or fenestrations may cause scarring that interferes with hearing.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Otorrhea:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Aural polyps.Aural polyps may produce foul, purulent and, perhaps, blood-streaked discharge. If they occlude the external ear canal, the polyps may cause partial hearing loss.
Basilar skull fracture.With a basilar skull fracture, otorrhea may be clear and watery and positive for glucose, representing cerebrospinal fluid (CSF) leakage, or bloody, representing hemorrhage. Occasionally, inspection reveals blood behind the eardrum. Otorrhea may be accompanied by hearing loss, CSF or bloody rhinorrhea, periorbital ecchymosis (raccoon eyes), and mastoid ecchymosis (Battle's sign). Cranial nerve palsies, decreased level of consciousness, and headache are other common findings.
Epidural abscess.With an epidural abscess, profuse, creamy otorrhea is accompanied by steady, throbbing ear pain; fever; and a temporal or temporoparietal headache on the ipsilateral side.
Myringitis (infectious).With acute infectious myringitis, small, reddened, blood-filled blebs erupt in the external ear canal, the tympanic membrane and, occasionally, the middle ear. Spontaneous rupture of these blebs causes serosanguineous otorrhea. Other features include severe ear pain, tenderness over the mastoid process and, rarely, fever and hearing loss.
Chronic infectious myringitis causes purulent otorrhea, pruritus, and gradual hearing loss.
Otitis externa.Acute otitis externa usually causes purulent, yellow, sticky, foul-smelling otorrhea. Inspection may reveal white-green debris in the external ear canal. Associated findings include edema, erythema, pain, and itching of the auricle and external ear canal; severe tenderness with movement of the mastoid, tragus, mouth, or jaw; tenderness and swelling of surrounding nodes; and partial conductive hearing loss. The patient may also develop a low-grade fever and a headache ipsilateral to the affected ear.
Chronic otitis externa usually causes scanty, intermittent otorrhea that may be serous or purulent and possibly foul-smelling. Its primary symptom, however, is itching. Related findings include edema and slight erythema.
Life-threatening malignant otitis externa produces debris in the ear canal, which may build up against the tympanic membrane, causing severe pain that's especially acute during manipulation of the tragus or auricle. Most common in patients with diabetes and immunosuppressed patients, this fulminant bacterial infection may also cause pruritus, tinnitus and, possibly, unilateral hearing loss.
Otitis media.With acute otitis media, rupture of the tympanic membrane produces bloody, purulent otorrhea and relieves continuous or intermittent ear pain. Typically, a conductive hearing loss worsens over several hours.
With acute suppurative otitis media, the patient may also exhibit signs and symptoms of an upper respiratory infection—sore throat, cough, nasal discharge, and headache. Other features include dizziness, fever, nausea, and vomiting.
Chronic otitis media causes intermittent, purulent, foul-smelling otorrhea commonly associated with tympanic membrane perforation. Conductive hearing loss occurs gradually and may be accompanied by pain, nausea, and vertigo.
Trauma.Bloody otorrhea may result from trauma, such as a blow to the external ear, a foreign body in the ear, or barotrauma. Usually, bleeding is minimal or moderate; it may be accompanied by partial hearing loss.
Tumor (malignant).Squamous cell carcinoma of the external ear causes purulent otorrhea with itching; deep, boring ear pain; hearing loss; and, in late stages, facial paralysis.
In squamous cell carcinoma of the middle ear, blood-tinged otorrhea occurs early, typically accompanied by hearing loss on the affected side. Pain and facial paralysis are late features.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Earache [Otalgia]:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Abscess (extradural).Severe earache accompanied by a persistent ipsilateral headache, malaise, and a recurrent mild fever characterizes an abscess, which is a serious complication of middle ear infection.
Barotrauma (acute).Earache associated with barotrauma ranges from mild pressure to severe pain. Tympanic membrane ecchymosis or bleeding into the tympanic cavity may occur, producing a blue drumhead; the eardrum usually isn't perforated.
Cerumen impaction.Impacted cerumen (earwax) may cause a sensation of blockage or fullness in the ear. Additional features include partial hearing loss, itching and, possibly, dizziness.
Herpes zoster oticus (Ramsay Hunt syndrome).Herpes zoster oticus causes burning or stabbing ear pain, commonly associated with ear vesicles. The patient also complains of hearing loss and vertigo. Associated signs and symptoms include transitory, ipsilateral, facial paralysis; partial loss of taste; tongue vesicles; and nausea and vomiting.
Keratosis obturans.Mild ear pain is common with keratosis obturans, along with otorrhea and tinnitus. Inspection reveals a white glistening plug obstructing the external meatus.
Mastoiditis (acute).Mastoiditis causes a dull ache behind the ear accompanied by a low-grade fever (99° to 100° F [37.2° to 37.8° C]). The eardrum appears dull and edematous and may perforate, and soft tissue near the eardrum may sag. A purulent discharge is seen in the external canal.
Ménière's disease.Ménière's disease is an inner ear disorder that can produce a sensation of fullness in the affected ear. Its classic effects, however, include severe vertigo, tinnitus, and sensorineural hearing loss. The patient may also experience nausea and vomiting, diaphoresis, and nystagmus.
Otitis externa.An earache characterizes acute and malignant otitis externa. Acute otitis externa begins with mild to moderate ear pain that occurs with tragus manipulation. The pain may be accompanied by a low-grade fever, sticky yellow or purulent ear discharge, partial hearing loss, and a feeling of blockage. Later, ear pain intensifies, causing the entire side of the head to ache and throb. Fever may reach 104° F (40° C). Examination reveals swelling of the tragus, external meatus, and external canal; eardrum erythema; and lymphadenopathy. The patient also complains of dizziness and malaise.
Malignant otitis externa abruptly causes ear pain that's aggravated by moving the auricle or tragus. The pain is accompanied by intense itching, purulent ear discharge, a fever, parotid gland swelling, and trismus. Examination reveals a swollen external canal with exposed cartilage and temporal bone. Cranial nerve palsy may occur.
Otitis media (acute).Otitis media is middle ear inflammation that may be serous or suppurative. Acute serous otitis media may cause a feeling of fullness in the ear, hearing loss, and a vague sensation of top-heaviness. The eardrum may be slightly retracted, amber, and marked by air bubbles and a meniscus, or it may be blue-black from hemorrhage.
Severe, deep, throbbing ear pain; hearing loss; and a fever that may reach 102° F (38.9° C) characterize acute suppurative otitis media. The pain increases steadily over several hours or days and may be aggravated by pressure on the mastoid antrum. Perforation of the eardrum is possible. Before rupture, the eardrum appears bulging and fiery red. Rupture causes purulent drainage and relieves the pain.
Chronic otitis media usually isn't painful except during exacerbations. Persistent pain and discharge from the ear suggest osteomyelitis of the skull base or cancer.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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