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Otalgia (Ear Pain)

Not all ear pain is otologic; the ears have rich sensory innervation from multiple nerves, and secondary pain is common. Most otologic ear pain has some associated physical findings; if none is present, a complete head and neck examination, including imaging, may be required to search for a source of referred otalgia.

Differential Diagnosis


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

Workup and Diagnosis

    • History
      –Onset, duration, and specific quality of pain
      –Ability to localize (may distinguish otologic from nonotologic)
      –Associated otologic symptoms: Otorrhea, hearing loss, imbalance, prior ear surgery, antecedent events
      –Pain associated with mastication, swallowing, voice change, purulent rhinorrhea
    • Otologic exam
      –Inspection and palpation of pinna, tragus, and preauricular area, and mastoid bone
      –Direct otoscopy for signs of external- or middle-ear infection or inflammation
      –Obstructing cerumen or foreign bodies must be removed to evaluate deeper structures
    • Complete head and neck exam
      –Nose and nasal cavities, oral cavity, and pharynx (particularly teeth and tonsils), TMJ
      –Examination of nasopharynx and larynx may require fiberoptic endoscopy
  • Tympanometry, if middle ear status (fluid, retraction, perforation) is not evident from otoscopy
  • CT or MRI
    –Useful to delineate extent of cholesteatoma, mastoiditis, petrous apicitis, tumor
    –May be necessary to evaluate either otologic disease or an ill child with nonotologic source (rule out abscess or tumor)

Treatment

  • Establish appropriate specific diagnosis as promptly as possible
  • If infectious process, initiate antimicrobial therapy
    –Topical (intraotic) antibiotic drops for otitis externa or otitis media with either a perforation or patent tympanostomy tube
    –Systemic (oral) for otitis media, nonviral pharyngitis, sinusitis
    –Parenteral antibiotics for abscess, mastoiditis
  • If odontogenic, dental referral
  • Adequate follow-up to ensure resolution of otalgia

Book Source Details

  • Book Title: In A Page: Pediatric Signs and Symptoms
  • Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
  • Year of Publication: 2007
  • Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Calf pain

Read excerpts from these other book chapters related to Calf pain:

Medical Books Excerpts
  • BACK PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • BREAST PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • CHEST PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • EYE PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • FACE PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • FLANK PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
  • [ read ]
  • GIRDLE PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • HEEL PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • HIP PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • JAW PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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  • Back Pain
  • "In A Page: Pediatric Signs and Symptoms" (2007)
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  • Chest Pain
  • "In A Page: Pediatric Signs and Symptoms" (2007)
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  • Hip Pain
  • "In A Page: Pediatric Signs and Symptoms" (2007)
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  • Knee Pain
  • "In A Page: Pediatric Signs and Symptoms" (2007)
  • [ read ]
  • LEG PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • ARM PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • EYE PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • HIP PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • Leg pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Arm pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Back pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Chest pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Eye pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Flank pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Jaw pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Neck pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Rectal pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Throat pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
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  • Back Pain
  • "A Pocket Manual of Differential Diagnosis" (1999)
  • [ read ]
  • Chest Pain
  • "A Pocket Manual of Differential Diagnosis" (1999)
  • [ read ]
  • Homans' sign
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Leg Pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Arm pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Back pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Chest pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Facial pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Flank pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Jaw pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Neck pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Rectal pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Throat pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Calf Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Chest Pain, Atypical
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Low Back Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Abdominal Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Chronic Pelvic Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Hip Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Knee Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Neck Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Pleuritic Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Scrotal Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Shoulder Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Eye Pain
  • "Field Guide to Bedside Diagnosis" (2007)
  • [ read ]
  • Hip Pain
  • "Field Guide to Bedside Diagnosis" (2007)
  • [ read ]
  • Homans' sign
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Abdominal pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Back pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Chest pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Eye pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Flank pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Jaw pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Neck pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Homans' sign
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Leg pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Arm pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Back pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Breast pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Chest pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Eye pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Facial pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Flank pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Jaw pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Neck pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Rectal pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Throat pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Abdominal Pain
  • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
  • [ read ]
  • Back Pain
  • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
  • [ read ]
  • Chest Pain
  • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
  • [ read ]
  • Leg pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Arm pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Back pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Chest pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Flank pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Jaw pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Neck pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • LEG PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • ARM PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • EYE PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • HIP PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
 

Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Calf pain



More About This Book:
Title: In A Page: Pediatric Signs and Symptoms
Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 1-4051-0427-9

 » Next page: Abdominal Pain (In A Page: Pediatric Signs and Symptoms)

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