EARACHE

EARACHE: Excerpt from Differential Diagnosis in Primary Care

The analysis of earache is much like that of dysuria: It is anatomic, and inflammation accounts for the vast majority of causes. Thus, otitis externa would be like urethritis and otitis media like cystitis, and so forth. Like cystitis, otitis media is often initiated by obstruction (e.g., swollen adenoids). Foreign bodies in the ear, like foreign bodies in the bladder, must always be looked for. Unlike dysuria, earache is often caused by referred pain. Thus, parotitis (e.g., mumps), temporomandibular joint (TMJ) syndrome, pharyngitis, and dental caries or abscesses may cause earache.

Approach to the Diagnosis

The approach to the diagnosis requires ear, nose, and throat examination; culture of any discharge; and x-ray film of the mastoids, petrous bone, TMJs; and, in some cases, the sinuses and teeth. A careful neurologic examination is necessary in unexplained otalgia. Referral to an otolaryngologist or neurologist is probably best for the busy physician who is unable to find the cause on a routine examination.

Other Useful Tests

1. Computed tomography (CT) scan of the mastoids (mastoiditis)
2. Magnetic resonance imaging (MRI) of the TMJs (TMJ syndrome)
3. Throat culture (streptococcal pharyngitis)
4. X-ray of the teeth (dental abscess)
5. Impedance tympanogram (otitis media)
6. Audiogram (otitis media)

Pictures

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins MD, FACP
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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