Ear pain

Ear pain (Otalgia)

Ear pain (otalgia) is a symptom of otitis media, eustachiitis, foreign bodies entering the ear canal. Soreness is also found in ear injuries, temporal bone, benign and malignant tumors, neurological diseases. To diagnose the causes of the pain syndrome, otoscopy, audiometry, radiography and computed tomography of the skull are performed. To establish the origin of the symptom, tests of the discharge from the ear, blood tests help. To relieve pain, local medications (ear drops) and systemic analgesics are used. Treatment includes medical and physiotherapeutic effects, if necessary, they resort to otosurgery.

Causes of ear pain
Otitis
Eustachiitis
Foreign body
Ear injuries
Ear tumors
Epidemic mumps
Neurological diseases
Complications of pharmacotherapy
Diagnostics
Treatment
Help before diagnosis
Conservative therapy
Surgical treatment
Prices for treatment
Causes of ear pain
Otitis media
Ear inflammation is the most common cause of soreness in children and adults. Taking into account the localization and extent of the lesion, the pains can be shooting, dull, pulsating or bursting. Usually discomfort is felt on one side, but bilateral inflammation is also possible. The symptom is combined with headache, malaise, fever. Otalgia manifests various variants of the inflammatory process:

External otitis media. Patients experience sharp pulsating pain sensations that are given to the lower jaw and neck. The discomfort is aggravated by talking, chewing food, swallowing. Typically, redness of the skin of the auricle and the visible part of the auditory canal. Hearing, as a rule, is not impaired.
Otitis media. The disease manifests itself with a sudden shooting pain in the ear, which periodically intensifies. The soreness lasts up to 3 days, then the pus goes into the outer ear, and the unpleasant sensations are dulled. Sometimes the symptoms are so strong that they interfere with sleep and work, are not removed by analgesics.
Internal otitis media (labyrinthitis). Pathology is characterized by moderate soreness in the ear and temporal zone, malaise. For labyrinthitis, attacks of dizziness and nausea are pathognomonic, which bother patients much more than pain syndrome. Hearing is often noticeably reduced.
A separate place among the causes of pain is occupied by the swimmer’s ear syndrome (external diffuse otitis media). Otalgia is the main sign of pathology. Pulsating or shooting pains prevail, which increase when pressing on the affected area, pulling the earlobe. Patients also complain of discomfort and swelling in the external ear canal, hearing impairment.

Eustachitis
For inflammation of the auditory (Eustachian) tube, dull pain and discomfort on the side of the lesion are typical. Patients describe their symptoms as a feeling of fluid transfusion in the ear, unpleasant swelling or congestion. Severe otalgia is observed in eustachiitis caused by sudden changes in atmospheric pressure. A specific sign of the disease is autophony — the feeling of resonance of one’s own voice in the ear.

Ear pain
Ear pain
Foreign body
When large objects get into the ear canal, patients are worried about bursting severe pains that are felt constantly and do not decrease after applying drops or painkillers. If the foreign body has sharp edges, in addition to the pain syndrome, bleeding from the ear opens or pain occurs sharply due to damage to the eardrum.

In addition to these symptoms, patients notice ear congestion, unilateral hearing impairment. Dizziness and headaches appear less often. If the object is in the ear for a long time, an inflammatory process begins, in which the otalgia increases, the pain becomes shooting or pulsating. Mucopurulent exudate is released from the ear canal.

Ear injuries
When the auricle is damaged, acute pains occur on the affected side, which eventually change to dull or pulsating (when a hematoma is formed). If the injury affects the auditory canal, in addition to severe pain, there is bleeding and hearing loss by the type of conductive hearing loss. Damage to the eardrum is characterized by severe pain syndrome, which gradually subsides, is replaced by hearing loss and congestion.

Injuries of the middle and inner ear are often found in the structure of TBI, which determines the features of clinical symptoms. Patients complain of excruciating pains that capture not only the ear, but also the temporal region, the mastoid process. Severe injuries cause excruciating headache without a clear localization. Typically, ear bleeding, a sharp decrease or absence of hearing.

Ear tumors
Benign neoplasms are accompanied by otalgia only when they reach a significant size and compression of the surrounding tissues. If the tumor is located near the eardrum, the patient is concerned about tinnitus, hearing loss. For malignant formations, burning pains are pathognomonic. At first, the pain is periodic in nature, as the tumor grows, the intensity of the pain syndrome steadily increases.

Epidemic mumps
With mumps, the pain is localized mainly in the parotid region, the projection zone of the affected salivary glands. Usually the pain syndrome spreads to the ear. According to the clinical picture, the infection may resemble otitis media or eustachiitis. Otalgia is felt more strongly when chewing and talking, feeling the affected area, the skin over which becomes stretched and glossy. The most intense bursting pains occur at night.

Neurological diseases
Neuralgia of the ear node is manifested by attacks of burning or pulsating unilateral pain, which is localized in the ear, as well as the area adjacent to it. Pain radiates to the back of the head, neck, temporomandibular joint. An attack of otalgia lasts from a few minutes to one hour, after which all symptoms disappear. Paroxysms are provoked by changes in temperature and humidity, changes in barometric pressure.

With neuralgia of the lingopharyngeal nerve, the pain is localized mainly in the root of the tongue, but often it gives into the ear. A painful attack is associated with chewing, coughing, eating too hot or cold food. Otalgia is also noted in ganglionitis of the knee node, which develops as part of a herpes infection (Ramsey Hunt syndrome). Moderate dull pain in the ear occurs with cochlear neuritis.

Complications of pharmacotherapy
When using drugs with an ototoxic effect, dull pains often occur, often of an intermittent nature. At the same time with otalgia, ringing, noise and whistling in the ears bother, hearing worsens. Unpleasant symptoms increase with head tilts in different directions, sharp turns of the trunk. Iatrogenic ototoxicity is most often manifested by aminoglycosides, loop diuretics, platinum derivatives.

Diagnostics
With complaints of otalgia, it is necessary to consult an otolaryngologist. A preliminary diagnosis is made already during visual examination, when signs of injury to the outer ear, suppuration or liquorrhea, tumor-like outgrowths in the auditory canal are detected. To determine the cause of pain, informative instrumental and laboratory diagnostic methods are included in the examination scheme:

Otoscopy. Examination with an otoscope is a simple method of diagnosing otitis media, neoplasms, boils. The study reveals hyperemia of the skin, swelling or retraction of the eardrum, purulent discharge. If the disease is complicated by the destruction of the auditory membrane, during otoscopy, the doctor will see the structures of the tympanic cavity.
Audiometry. A set of diagnostic methods is prescribed to determine the presence of hearing disorders and their severity. To obtain a complete clinical picture, several types of research are used: speech, tone or computer audiometry.
Radiography of the temporal bone. Radiological methods allow to study in detail the structure of the inner and middle ear. On X-rays, it is possible to detect bone fractures, signs of inflammation or destruction of the mastoid process, deformation of structures due to the growth of neoplasms.
Additional methods. To clarify the localization of the pathological process in traumatic injuries of the ear area, a CT scan of the skull, an MRI of the brain is performed. Diagnostic search includes examination of the vestibular apparatus (vestibulometry, stabilography). In case of probable inflammation of the eustachian tube, it is advisable to perform rhinoscopy, pharyngoscopy.
Laboratory tests. With otitis media, bacterioscopic and bacteriological analysis of the discharge from the auditory canal is shown. Children with possible mumps are diagnosed with serological reactions (RSC, ELISA). To verify the diagnosis of a malignant tumor, a histological analysis of biopsies is performed.
Otoscopy for ear pain
Otoscopy for ear pain
Treatment
Help before diagnosis
To reduce otalgia, ear drops with local anesthetics or oral tablets with analgesics are used before a visit to the doctor. Medications can be used if the pain did not occur against the background of an injury. The bones of the skull and the brain are quickly involved in the pathological process that has affected the ear, so self-medication is unacceptable. A qualified ENT doctor should provide assistance to patients with otalgia.

Conservative therapy
Treatment involves the use of local or systemic drugs or a combination of them. With otitis media, ear drops containing antibacterial, anti-inflammatory and anti-allergic substances are used, an ear toilet is performed. To improve the outflow of exudate from the tympanic cavity, vasoconstrictors are instilled into the nose. To reduce the pain syndrome in the first days (before the breakthrough of the auditory membrane), heated 96% alcohol is dripped into the ear.

To eliminate the consequences of taking ototoxic drugs, ATP and galantamine are prescribed, which stimulate regeneration processes. Nootropics help to improve the nutrition of the structures of the auditory analyzer. Sedatives, cholinolytic agents, metabolic and vasoactive drugs are recommended to influence the neurological causes of otalgia. Severe pain paroxysms require taking anticonvulsants.

In practical otolaryngology, physiotherapy methods are effective. To stop the inflammatory process and stimulate local immunity, microwave therapy, laser therapy, UHF are performed. For the prevention of auditory disorders during the recovery period, a pneumatic massage of the eardrum is performed. Reflexotherapy, amplipulstherapy helps to eliminate paroxysms of neuralgia of the ear node.

Surgical treatment
The tympanic cavity is cleaned of pus during myringotomy, followed by washing the ear with antibacterial solutions. With chronic otitis media and the absence of the effect of conservative measures, antrodrenage is performed in the mastoid process. Indications for surgical treatment are external cholesteatomas, exostoses, abscesses.

To eliminate the consequences of middle ear injury, reconstructive operations are prescribed: myringoplasty, tympanoplasty, mastoidoplasty. In case of damage to the inner ear, otosurgical interventions are performed to restore the integrity of anatomical structures. In severe illnesses and injuries accompanied by hearing loss, the patient needs the selection of a hearing aid or cochlear implantation.

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