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ENT Otolaryngology/ Otorhinolaryngology ENT Head & Neck Surgery Gateways of body Special senses. Taste, hearing,
Smell, Balance Narrow cavities. Special equipment Complex anatomy
Sensory Supply Of the Ear 5th CN - Auriculotemporal branch 1st and 2nd cervical nerves. 9th CN - Jacobson branch 10th CN- Arnold branch 7th CN - Ramsey hunt branch
EVALUATION OF OTALGIA History
Ear symptoms Nasal symptoms swallowing disorders recent trauma General Symptoms
Examination Genral physical examination Complete ENT examination Rhinoscopy, nasopharyngoscopy, and indirect
laryngoscopy. Palpation of the neck is important to look for thyroid
disease and 1lymphadenopathy
PRIMARY OTALGIA
PINNA Trauma Haematoma Infected Eczema Frost Bite Sunburn Chondrodermatitis nodularis chronica helicis Infected Basal Cell/Squamaous cell Ca
PRIMARY OTALGIA
Meatus Impacted Wax Keratosis Obturans Boil Otitis Externa Malignant Otitis externa Herpes Zoster Oticus Trauma
PRIMARY OTALGIA Middle Ear
Acute Otitis Media Otitic Barotrauma Bullous Myringitis Haemotympanum Carcinoma Complicated CSOM Acute Mastoiditis
Inner Ear Noise Tinnitus described as throbbing pain
REEFERRED EAR ACHE Tonsillitis Nasal Polyps Mumps Thyroid disease’s Laryngitis Long Styloid Process Dental Abnormalities Oral Ulceration TMJ Disordres
IMPACTED WAX Normal secretion of ceruminous
glands Cause of impaction Pain, deafness, tinnitus, Removal Prevention
FURUNCLOSIS EAR (Boil) Staphylococal Infection hair follicle of Ext Meatus Clinical Features
Pain full swelling in outer 1/3rd of ext auditory canal Discomfort aggravated on movement of jaw Deafness
Treatment Aural dressing
Antibiotic & Steroid Cream or icthamol Antibiotics
Cloxacillin,Flucloxacillin,Cephradine Analgesics Most drain spontaneously Blood Sugar Levels
Diffuse Otitis Externa Diffuse inflammation of meatal skin Aetiology
Hot humid climate Swimmers Trauma
Unskilled instrumentation Scratching ear canal with hair pin Excessive cleaning of ear canal after swimming
Existing CSOM Causative Organisms
Pseudomonas aeruginosa Staph.aureus B.proteus
Diffuse Otitis Externa Clinical features
Hot burning sensation Pain Serous or purulent discharge Meatal skin is red warm and tender Cheesy debris in the deep meatus
Treatment Aural toilet Aural dressing Topical antibiotics with steroids
MALIGNANT OTITIS EXTERNA Progressive infection of meatus,
surrounding soft tissue and skull base Causative Organism
Pseudomonas aeroginosa Predisposing Factors
Elderly diabetics Immunocompromised
MALIGNANT OTITIS EXTERNA Clinical Features
Excruciating Pain Granulations in the Ext ear canal IX, X, XI CN palsies Intracranial complications
Treatment I/V Antibiotics high doses 6-8 weeks Glycemic control Debridement of devitalized tissue & bone
HERPES ZOSTER OTICUS Viral Infection affecting genicualte ganglion of
facial nerve Clinical Features Severe otalgia Vesicular rash on the concha or pinna VII Nerve Palsy (Ramsay Hunt Synd.) Treatment Oral acyclovir Pain continues months after the rash as post
herpetic neuralgia requiring Tricyclic antidepressants
OTOMYCOSIS
Fungal Infection of ear canal Aspergilis niger, Aspergilis fumigatis, Candida
albicans Predisposing Factors
Hot & Humid climate Topical antibiotics drops for CSOM or otitis
externa
OTOMYCOSIS Clinical Features
Itching pain in ear Discharge with musty color Fungal mass looks like Wet piece of filter paper
Treatment Aural Toilet Antifungal Agents
Clotrimazole 2% salicylic acid in alcohal
ACUTE OTITIS MEDIA
Acute Infection of middle ear by pyogenic organisms.
Common in infants and children Bacteriology
Strep.Pneumonae,H INF, Moraxella Catarrhalis Clinical Features
Otalgia,Fever,Ear discharge Red Congested buldging TM Small Perforation with ear discharge
ACUTE OTITIS MEDIA
Managememnt Antibiotics Antipyretics Decongestants
Systemic,Topical Ear Toilet Myringotomy
Pain Not responding to above treatmenty Development of complications
Facial paralysis etc
OTITIC BAROTRAUMA
Non suppurative condition due to failure of eustacchian tube to maintain middle ear pressure at ambient atmospheric level
Mechanism When atmospheric pressure is higher than middle
ear pressure by a critical of 90 mm of hg eustachian tube gets locked.- -ve pressure in middle ear - retraction of tympanic membrane-hyperaemia,transudation and haemorrhage in the middle ear.
OTITIC BAROTRAUMA Treatment
Nasal decongestants Antihistamines Myringotomy
Prevention Swallow during descent Donot sleep during descentdecreases swallows Effects
opening of eustachians tube Autoinflation of tube by valsalva during descent.
Acute Mastoiditis Inflammation of mucosal lining of antrum and
mastoid air cell system. Clinical Features
Pain behind the ear Fever Ear Discharge Mastoid tenderness Ear discharge Sagging of posterosuperior meatal wall Swelling over the mastoid Deafness
Acute Mastoiditis Antibiotics Myringotomy
Pus under tension not resolving with medical therapy Cortical Mastoidectomy
Subpreiosteal abscess Positive reservoir sign No change in symptoms after 48 hrs of medical
management Complications
Facial palsy, labrynthitis,intracranial complications.