Ear Pain/Discharge
Differential Overview
Ear Pain
❑ Acute otitis media
❑ Acute otitis externa
❑ Eustachian dysfunction
❑ Temporomandibular joint arthritis
❑ Traumatic tympanic membrane rupture
❑ Foreign body, external auditory canal
❑ Erysipelas
❑ Herpes zoster oticus
❑ Dental abscess
❑ Frostbite
❑ Relapsing polychondritis
❑ Malignant otitis externa
❑ Acute mastoiditis
❑ Nasopharyngeal cancer
Ear Discharge
❑ Otitis externa
❑ Eczematoid dermatitis
❑ Low-viscosity cerumen
❑ Otitis media with perforation
❑ Foreign body
❑ Psoriasis
❑ Herpes zoster oticus
Diagnostic Approach
If ear pain is present without ear findings, consider referred pain from the tonsils, teeth, trachea, or temporomandibular joint. Ear pain may be an early sign of nasopharyngeal carcinoma. Lesions of the anterior portion of the tongue refer pain in front of the ear whereas the posterior one-third of the tongue refers pain to within the ear.
Clinical Findings
Acute otitis media The sine qua non of acute infection is erythema of the tympanic membrane. The membrane is usually also opaque and bulging, with the light reflex and bony landmarks obscured. It does not move with pneumoscopy.
Acute otitis externa There is pain with traction on the pinna. The external auditory canal is red, edematous and crusty, and has a serous to purulent discharge, with itching as a prominent symptom.
Eustachian dysfunction Commonly known as serous otitis, it occurs in the setting of an upper respiratory infection or seasonal allergies. Blockage usually causes a pressure sensation. The tympanic membrane is not red but may be dull in appearance due to fluid behind it. Sometimes an air-fluid level or bubbles can be seen behind the tympanic membrane.
Temporomandibular joint arthritis Pain radiates into the masseter, which may be tender. There is often a click or crepitance over the TMJ, and symptoms are worsened by opening the mouth. A history of bruxism may be elicited.
Traumatic tympanic membrane rupture It commonly occurs with introduction of a foreign body or a blow to the ear. Blood issues from the ear. Careful attention to the tympanic membrane will reveal the disruption although distortion of the landmarks may make it difficult to get your bearings.
Foreign body, external auditory canal It is readily visible on ophthalmoscopy.
Erysipelas The pinna is bright red and tender, and the redness may extend onto the adjacent face. Periauricular lymphadenitis is present.
Herpes zoster oticus Vesicles and crusting are present in the external auditory canal. Tinnitus, decreased hearing, vertigo, and ipsilateral facial palsy occur.
Dental abscess The lower molars refer pain to the ear. There will be concussion tenderness over the affected tooth and usually a swollen jaw.
Frostbite Following cold exposure, the ear is red, edematous, and painful.
Relapsing polychondritis The key finding is that the inflammation and redness spare the earlobe. Associated findings include inflammation of the cartilage of the nose or thyroid cartilage and/or symmetrical polyarthritis.
Malignant otitis externa It occurs in diabetics, with severe ear pain, green and purulent discharge, and fleshy or friable granulation tissue at the junction of the cartilage and bony canal.
Acute mastoiditis There is exquisite tenderness and swelling behind the ear.
Nasopharyngeal cancer Deep pain referred to the ear occurs especially in nasopharyngeal cancer growing near the origin of the eustachian tube. The pain will be persistent. The patient will have a sensation of fullness or obstruction within the nasopharynx.
Eczematoid dermatitis Because this dermatitis is very pruritic, the patient will have a history of frequent scratching or swabbing in the ear.
Low-viscosity cerumen The ear is not itchy or tender, and there is often a history of liquid introduced externally.
Otitis media with perforation A bright red perforated tympanic membrane can be seen if the fluid is gently swabbed or lavaged out. Copious otorrhea with slight maceration or a red canal suggests chronic otitis media with perforation. A pulsating mucopurulent discharge, the “lighthouse sign,” may be seen.
Psoriasis Silver scales on an erythematous base are evident elsewhere on the body, usually in the scalp or behind the ear.
Book Source Details
- Book Title: Field Guide to Bedside Diagnosis
- Author(s): David S. Smith
- Year of Publication: 2007
- Copyright Details: Field Guide to Bedside Diagnosis, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Ear symptoms
Read excerpts from these other book chapters related to Ear symptoms:
Medical Books Excerpts
- EARACHE
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- EARACHE
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- Earache
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Otorrhea
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Hearing loss
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Otorrhea
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Hearing Loss
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Earache
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Otorrhea
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Earache
- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
- [ read ]
- Otorrhea
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
- EARACHE
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright Details: Field Guide to Bedside Diagnosis, Copyright © 2008 Williams & Wilkins.
More About Causes of Ear symptoms
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More About This Book:
Title: Field Guide to Bedside Diagnosis
Authors: David S. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 0-78178-165-5
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» Next page: Hearing loss (Handbook of Diseases)
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