Earache [Otalgia]

Earaches usually result from disorders of the external and middle ear associated with infection, obstruction, or trauma. Their severity ranges from a feeling of fullness or blockage to deep, boring pain. At times, it may be difficult to determine the precise location of the earache. Earaches can be intermittent or continuous and may develop suddenly or gradually.

History and physical examination

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

Ask 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 noise in his ears? Ask about dizziness or vertigo. Does it 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.

Find out if the patient has flown, been to a high-altitude location, or been scuba diving.

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 discharge, impacted cerumen, foreign bodies, tenderness, or swelling. Examine the tympanic membrane: Is it intact? Is it pearly gray (normal)? 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 the watch tick, whispered voice, Rinne, and Weber's tests to assess for hearing loss.

Medical causes

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.

Nursing considerations

▪ Administer an analgesic.

▪ Apply heat to relieve discomfort.

▪ Instill eardrops if necessary.

Patient teaching

▪ Teach the patient or the parents how to instill drops if they're prescribed for home use.

▪ Explain the importance of taking prescribed antibiotics correctly.

▪ Explain ways to avoid vertigo.

▪ Instruct the patient and family about ways to avoid ear trauma.

▪ Explain the cause of the earache once a diagnosis has been established.

Pictures

Book Source Details

• Book Title: Nursing: Interpreting Signs and Symptoms
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Ear sounds

Read excerpts from these other book chapters related to Ear sounds:

Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Ear sounds

• Back to symptom: Ear sounds: Introduction (review 109 causes)
• Next Book Extract About Ear sounds: EARACHE (Differential Diagnosis in Primary Care)
• All Book Extracts: All Online Book Extracts for Ear sounds

More About This Book: Title: Nursing: Interpreting Signs and Symptoms Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-668-7

 » Next page: EARACHE (Differential Diagnosis in Primary Care)

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 (Differential Diagnosis in Primary Care)
• HALLUCINATIONS (Differential Diagnosis in Primary Care)
• TINNITUS AND DEAFNESS (Differential Diagnosis in Primary Care)
• Videos relating to Ear sounds
• Diagnosis Checklist for Ear sounds

Tools & Services:

• Bookmark this page
• Take a survey relating to Ear sounds
• 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