Earache

Earache: Excerpt from Signs & Symptoms: A 2-in-1 Reference for Nurses

Also known as otalgia, earaches usually result from disorders of the external and middle ear that are associated with infection, obstruction, or trauma. Their severity ranges from a feeling of fullness or blockage to deep, boring pain. It may be difficult to determine the precise location of an earache. Earaches can be intermittent or continuous and may develop suddenly or gradually.

History

Ask the patient to characterize the earache. How long has he had it? Is it intermittent or continuous? Is it painful or slightly annoying? Can he pinpoint the site of the ear pain? Does he have pain in any other areas such as the jaw?

Also ask the patient about recent ear injury or other trauma. Does swimming or showering trigger ear discomfort? Is discomfort associated with itching? If so, find out where the itching is most intense and when it began. Ask about ear drainage and, if present, have the patient characterize it. Does he hear ringing, “swishing,” or other noises in his ears? Ask about dizziness or vertigo. Do these symptoms worsen when the patient changes position? Does he have difficulty swallowing, hoarseness, neck pain, or pain when he opens his mouth?

Find out if the patient has recently had a head cold or problems with his eyes, mouth, teeth, jaws, sinuses, or throat. Disorders in these areas may refer pain to the ear along the cranial nerves. Also find out if the patient has recently flown, been to a high altitude location, or been scuba diving.

Physical assessment

Begin your physical examination by inspecting the external ear for redness, drainage, swelling, or deformity. Then apply pressure to the mastoid process and tragus to elicit tenderness. Using an otoscope, examine the external auditory canal for lesions, bleeding or other discharge, impacted cerumen, foreign bodies, tenderness, or swelling. Examine the tympanic membrane. Is it intact? Look for tympanic membrane landmarks: the cone of light, umbo, pars tensa, and the handle and short process of the malleus. (See Using an otoscope correctly.) Perform watch tick, whispered voice, Rinne, and Weber’s tests to assess for hearing loss.

Medical causes

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.

Special considerations

Administer an analgesic, and apply heat to relieve the patient’s discomfort. Instill eardrops if necessary.

Pediatric pointers

Common causes of earache in children are acute otitis media and insertion of foreign bodies that become lodged or cause infection. Be alert for crying or ear tugging in a young child — nonverbal clues to earache.

To examine a child’s ears, place him in a supine position with his arms extended and held securely by his parent. Then hold the otoscope with the handle pointing toward the top of the child’s head, and brace it against him using one or two fingers. Because an ear examination may upset the child with an earache, perform it at the end of your physical examination.

Patient counseling

Teach the patient or his parents how to instill eardrops if they’re prescribed for home use. Encourage the patient to complete the full course of antibiotics if prescribed. If the patient experiences vertigo, tell him to rise slowly from a sitting or lying position. Warn the patient not to insert anything into the ear to avoid trauma, infection, and ear pain.

Pictures

Book Source Details

• Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.

More About Earache

• Back to disease: Earache: Introduction
• Next Book Extract About Earache: Earache (The Diagnostic Approach to Symptoms and Signs in Pediatrics)
• More Book Extracts: All Online Books for Earache

More Medical Textbooks Online about Earache

Review other book chapters online related to Earache:

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Signs & Symptoms: A 2-in-1 Reference for Nurses Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-318-1

 » Next page: Earache (The Diagnostic Approach to Symptoms and Signs in Pediatrics)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Earache (The Diagnostic Approach to Symptoms and Signs in Pediatrics)
• Otorrhea (Nursing: Interpreting Signs and Symptoms)
• Earache [Otalgia] (Nursing: Interpreting Signs and Symptoms)
• AURAL DISCHARGE (OTORRHEA) (Differential Diagnosis in Primary Care)
• EARACHE (Differential Diagnosis in Primary Care)

Tools & Services:

• Bookmark this page
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City