Ear Problems in day to day Practice

We are going to discuss very common conditions encountered in general practice.

Otalgia means Earache, pain in and around the ear. By and large it is caused by inflammation and trauma.

Primary otalgia commonly results from skin lesions such as furuncle, impacted wax, foreign body, otitis externa and acute otitis media (AOM) etc.

In few cases referred pain arises from head and neck regions due to common nerve supply e.g. few patients get ear pain because of dental caries, gum abscess and due to upper respiratory tract infections like acute tonsillitis and peri-tonsillar abscess.

Management of Otalgia relies on underlying cause.

Acute Otitis Media (AOM)

AOM is common condition in general practice. AOM is an acute pyogenic inflammation of middle ear. Middle ear includes eustachian tube, middle ear aditus, antrum and mastoid air cell.

Most of the time infection from tonsils, sinus and pharynx travels to middle ear via eustachian tube and in few cases because of preexisting tympanic membrane perforation.

Atmospheric changes while flying and deep-water diving can affect eustachian tube.

AOM evolves in 5 stages.

In the beginning Eustachian tube occlusion occur because of oedema and hyperaemia of nasopharynx leads to fullness and mild pain in ear.

Second stage is pre suppuration inflammatory stage wherein exudates appearing in middle ear leads to throbbing pain in ear and fever.

If formation of pus occurs in middle ear and then tympanic membrane starts bulging, this stage is called as suppurative which causes excruciating pain in ear and tenderness over mastoid antrum.

Subsequently, stage of resolution develops with rupture of tympanic membrane and otorrhoea. On examination blood tinged ear discharge is noticed and thereafter pain subsides.

If infection spreads to mastoid or other neighboring structure it is called as stage of complication. The diagnosis is mainly clinical.