Ear Pain

Ear Pain  —  Differential Diagnosis

Acute Pain Only

Any Time Frame

Chronic

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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