Ear Pain

Ear Pain  —  Differential Diagnosis

Acute Pain Only Otitis Media Otitis Externa Zoster Local Furuncle

Any Time Frame Cerumenosis Eustachian Tube Dysfunction Mastoiditis (rare) Chronic TMJ Syndrome [???]

SUMMARY  APPROACH (copied from main posting)

1.  Manipulate External Ear  (Tug on the Pinna, Push on the Tragus)

• Exquisitely tender →  Otitis Externa
• Peek in canal: full of exudate confirms Dx

2.  Examine TM

• Bulging, can’t distinguish landmarks, maybe red →  Otitis Media

3.  Canal Full of Cerumen  →  Cerumenosis

• Clean canal: TM normal & symptoms better confirms Dx

None of Above

4.  Examine canal carefully for Furuncle (especially near meatus)

5.  Consider Zoster, especially if:

• Vertigo
• Vesicles on canal
• Facial (“Bell’s”) Palsy

6.  Tap on mastoid process behind ear: very tender →  ? Mastoiditis

• very rare; often febrile
• often there’s a destroyed TM
• Needs CT

Still None of Above

7.  Diagnose Eustachian Tube Dysfunction

• Dx confirmed if retracted TM (may not be present)
• Dx suggested if concurrent nasal Sx
• Condition common: default Dx if nothing else

Chronic Ear Pain (with normal TM)

a)  Dx Eustachian Tube Dysfunction

• Treat w/ Antihistamine & Nasal Steroid
• If no response, consider Dx of:

b)  Atypical Facial Pain Syndrome  (or “TMJ”)

• Esp. if masseter or temporal muscles tender to palpation

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