Causes of Earache
List of causes of Earache
Following is a list of causes or underlying conditions
(see also Misdiagnosis of underlying causes of Earache)
that could possibly cause Earache includes:
More causes:
see full list of causes for Earache
Causes of Earache (Diseases Database):
The follow list shows some of the possible medical causes of Earache
that are listed by the Diseases Database:
Source: Diseases Database
Earache Causes: Book Excerpts
Earache as a complication of other conditions:
Other conditions that might have
Earache as a complication may,
potentially, be an underlying cause of Earache.
Our database lists the following as having
Earache as a complication of that condition:
Earache as a symptom:
Conditions listing Earache
as a symptom may also be potential underlying causes of Earache.
Our database lists the following as having
Earache as a symptom of that condition:
Medications or substances causing Earache:
The following drugs, medications, substances or toxins are some of the possible
causes of Earache 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.
See full list of 13
medications causing Earache
Related information on causes of Earache:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Earache may be found in:
Causes of Earache: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Earache.
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
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
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
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
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
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.
» READ BOOK EXCERPT ONLINE »
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.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
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
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 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.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
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
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
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Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
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.
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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.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
Earache:
Earache - etiology
(The 5-Minute Pediatric Consult)
- Primary otalgia:
- Infectious: Acute otitis media, otitis externa, varicella virus, herpes simplex virus, cellulitis; furunculosis (localized abscess of cartilaginous portion of ear canal [outer 1/3]), mastoiditis, myringitis (inflammation and blisters on the tympanic membrane), perichondritis (inflammation of auricle without ear lobe involvement)
- Trauma: Foreign body; lacerations, abrasions; blunt trauma; barotrauma (injury to middle ear arising from abrupt changes in pressure [e.g., from air travel, scuba diving]); thermal injury to auricle; caustic burns from hearing aid batteries
- Tumor: Rare in pediatric patients but may involve any of the ear structures, including skin, bone, vascular, and neural components— rhabdomyosarcoma; lymphoma; pheochromocytoma
- Allergic/inflammatory: Otitis media with effusion, eczema, psoriasis, allergic reaction to topical antibiotic and ceruminolytic agents
- Functional: Eustachian tube dysfunction
- Miscellaneous: Impacted cerumen, eosinophilic granuloma, Wegener granulomatosis, aural neuralgia (brief, sharp pain localized deep in ear without radiation; unknown cause)
- Secondary otalgia:
- Infectious: Dental abscess, gingivitis, stomatitis such as herpes simplex or coxsackie virus, tonsillitis, peritonsillar abscess, retropharyngeal abscess, mumps, sinusitis, cervical adenitis, laryngitis, sialadenitis, Ramsay Hunt syndrome (viral neuritis of facial nerve secondary to herpes zoster)
- Trauma: Dental trauma; penetrating injuries to the oropharynx; lacerations; post-tonsillectomy/ adenoidectomy; burn (caustic, thermal, or electrical); injuries to the neck and cervical spine, including fractures and muscle tension
- Tumor: Oropharyngeal/laryngeal tumors, intracranial tumors (rarely will present with ear pain)
- Allergic/inflammatory: Allergic rhinitis, cervical spine arthritis
- Miscellaneous: Aphthous ulcers (canker sores), foreign body lodged in piriform sinus or esophagus, esophagitis, temporomandibular joint (TMJ) disease, migraine, thyroid inflammation, psychogenic (rarely), “pillow otalgia” (owing to sleep position)
» READ BOOK EXCERPT ONLINE »
Source: The 5-Minute Pediatric Consult, 2008
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