Ear Pain and Hearing

Ear Pain

Primary Otalgia (Origin Within Ear)

  • Otitis externa

    • Refer to ENT if tympanic membrane is ruptured or cannot be visualized

    • Treatment for patient with intact tympanic membrane:

      • Disimpact ear canal with 1:1 dilution of 3% hydrogen peroxide

      • Ciprofloxacin 0.3%/dexamethasone 0.1% (Ciprodex) 4 drops topically twice daily x 7 days for all patients age ≥ 6 months

      • Naproxen 500 mg BID for pain control

      • Use ear plugs to avoid introduction of water into ear during treatment (e.g. while bathing)

  • Acute otitis media: Criteria for diagnosis

    • New onset otorrhea and no evidence of otitis externa

    • Mild tympanic membrane bulging new onset ear pain

    • Severe tympanic membrane bulging

  • Foreign object insertion

  • Eustachian tube dysfunction

Secondary Otalgia (Origin Outside Ear)

  • Emergent: Temporal arteritis

  • Temporomandibular joint syndrome

  • Dental infection

  • Cervical adenopathy

  • Cervical spine arthritis

  • GERD (referred pain due to CN IX and X irritation)

Acute Hearing Loss

Pathophysiology

  • Conductive: Obstruction of external/middle ear interferes with pressure wave (sound) conduction

    • Often reversible

    • Rinne negative (bone louder than air) and Weber heard in affected (diseased) ear

  • Sensorineural: Inner ear or auditory nerve pathology prevents transmission of sensory information to CNS

    • Often permanent

    • Rinne false positive (air louder than bone) and Weber heard in unaffected (well) ear

  • Performing physical exam: See Oxford Medical Education

Etiology

  • Common

    • Otitis externa

    • Cerumen impaction

    • Foreign body

    • Benign tumors: Exostosis, osteoma polyps

  • Emergent

    • Temporal bone fracture

    • Necrotizing otitis externa

    • External ear canal neoplasm