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Ear, Nose, and Throat – Otalgia (Ear Pain)
Whiteboard Animation Transcript
with Russell Hollins, MD
https://medskl.com/Module/Index/otalgia
Otalgia, or ear pain, is a complex diagnostic challenge due to the numerous local conditions that can trigger it, as well as the multitude of near and distant sites that can refer pain to the ear. The way I approach ear pain is to classify it as arising from the external ear, from the middle ear, or from distant sites causing referred pain.
Here are some common causes of pain under each heading that you should always consider:
Pain arising in the external ear can be due to an infection, such as otitis externa or herpes simplex/zoster infection. Trauma to the external ear from burns or frostbite can also cause external ear pain. Finally, keep in mind the possibility of a foreign body impaction (such as a Q-tip) or carcinoma of the external canal.
Middle ear pain is most commonly due to acute otitis media. Think of this in a patient with fever, ear pain, and a bulging tympanic membrane on otoscopic examination.
Mastoiditis can also cause ear middle ear pain. Consider this in a patient with fever, lethargy, and tenderness and redness behind the ear with possible drainage. These patients should be referred to an ENT service for assessment and immediate treatment to prevent complications.
Pain to the ear can also be referred from other structures in the head and neck. If no pathology is found on ear exam, complete a thorough head and neck exam to identify a source of the pain. Common causes of referred pain include TMJ disorders, dental pain, cervical pain, migraine, and trigeminal neuralgia.
Always complete a thorough history and examination of the ear and of the head and neck on a patient presenting with ear pain. Patients with pain not responding to medication or with complications of ear pathology should be referred to an ENT specialist for further investigation and management.
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“GAS or streptococcus pyogenes is the most common bacterial cause of acute tonsillitis.
Here is a mouth with pharyngotonsilitis, inflammation of both the pharynx and tonsils. Here is a photo of bacterial tonsillitis. Pharyngotonsillitis caused by GAS is sometimes referred to as strep throat. The majority of episodes of pharyngitis are caused by viral infections which are usually treated conservatively. However, early recognition of s.pyogenes is important since failure to appropriately treat strep throat may lead to GAS complications. Unfortunately, distinguishing between viral and bacteria can be difficult.
The group a streptococcus are beta haemolytic cocci able to produce some exotoxins and also contain many surface antigens that play a vital role in its pathophysiology such as m proteins. Transmission of strep throat is through saliva and nasal secretion from an infected person.”
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Dry throat is a symptom with which patients can present for a mistaken meaning other symptoms, they will not be able to tell us what exactly their feeling and hence the cell is a dry throat. When somebody says their throat is dry means they become thirsty, they want to drink water to get some relief. Patients say that they have dry throat but they can actually be having an infection in the throat like pharyngitis, it’ll be sore. Some patients will have reflux disease which will be causing some soreness in the throat. Our throats lubricated by secretions, these are produced either in the nose in the form of mucus which can Trickle down constantly from the nose and sinuses into the stomach, which happens in every normal human being to the extent of between 1 to 1.5 litres per day and similar amount of saliva which is produce in the oral cavity from the salivary gland, which we tend to swallow when we speak or eat. So that both these Fluids tend to lubricate mouth, tongue, the back portion of throat and the throat in the hole. Now whenever there is a discrepancy or some sort of arrangement in production of the Fluids or the drying up off the fluids then you can have a dry throat. Supposing you have a nasal obstructions, you have a cold or your nose get blocked very frequently, then without your knowledge you’ll be actually breathing through the mouth. Now when dry air goes through the mouth it tends to dry of saliva more quickly than nasal secretions which causes dry throat. So dry throat means an indirect evidence of nasal obstruction, you might be having dry throat in the night mean that you are you might be a snower, you might be an obligatory mouth breather and will be snoring and hence you can have dry throat. You can also have dry throat especially in the elderly people who are on multiple medications, many of the medications have Side Effects, drugs which are like amitriptyline which is a tricyclic antidepressant or people who are hypertensive can have dry throat. Very rarely you pick up personally diabetic patient because the present with dry throat and say my throat gets very dry and I need to drink water very frequently and I also pass urine very frequently, this can be a very unusual presentation but they can be picked up.
Dr. Martin, an Emergency Medicine physician at Ohio State’s Wexner Medical Center, offers tips to help you recognize when your sore throat may be something more severe. If you’re experiencing any of these symptoms, you may want to consider seeing a doctor.
To find the right level of care for you, visit http://medicalcenter.osu.edu/patientcare/hospitals_locations/primary_care/Pages/index.aspx
HOW TO TREAT SORE THROAT AT HOME – AT HOME REMEDIES FOR STREP THROAT.
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CAUSES OF SORE THROAT
Infectious causes include bacteria and viruses that infect your throat.
Viruses that cause a sore throat include:
Rhinoviruses which causes common cold, Influenza virus, mononucleosis virus, measles and varicella virus.
A number of bacterial infections can cause a sore throat.
The most common is Streptococcus pyogenes (group A streptococcus) which causes strep throat.
Now there are many cases of sore throat which are not caused by any of these pathogens and these come under the non-infectious causes of sore throat. These can include
Allergies to pet , molds, dust and pollen can cause a sore throat.
Sore throat due to irritation with Irritants like tobacco smoke and chewing tobacco. Drinking excessive alcohol and eating spicy foods can also irritate your throat.
Sore throat can also develop due to a strain in the vocal cords which can be caused by excessive yelling, talking loudly or talking for long periods without rest.
Gastroesophageal reflux disease (GERD) which is a digestive system disorder people suffer from sore throat due to acid reflux.
Tumors of the throat, tongue or larynx can cause a sore throat.
Ear infections are a common problem for children and adults. Dr. Heather Gomes, Board Certified Otolaryngologist at Boys Town Ear, Nose & Throat Institute, explains the symptoms of an ear infection, the treatment options and when you should consult an ENT physician. For more information about Dr. Gomes, visit http://www.boystownhospital.org/physiciandirectory/Pages/EarNoseThroat/HeatherJGomesMD.aspx
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Sore throats are most often caused by either a virus or bacteria. Dr. Jane Emanuel, Board Certified Otolaryngologist at the Boys Town Ear, Nose & Throat Institute, explains additional causes of sore throats, when you should see a doctor and the treatment options. for more information, visit www.boystownhospital.org
A sore throat is a common symptom of an upper respiratory infection such as a cold or flu. It’s also a symptom of a bacterial infection commonly referred to as strep throat. How can you tell if your child’s sore throat is caused by a viral or bacterial infection? Mayo Clinic family medicine specialist Dr. Tina Ardon helps make the distinction.
More health and medical news on the Mayo Clinic News Network. https://newsnetwork.mayoclinic.org/
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Cough and sore throat season are upon us. There is no time like now to learn about step throat and rheumatic fever. Remember it is learning made simple.
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Is your child complaining of a dry and itchy throat? He or she may have a sore throat caused by a viral infection .
“Sore throats are very common, especially amongst school-aged children, says Dr. Nipunie Rajapakse, a Mayo Clinic pediatric infectious disease specialist. “Some of the symptoms that a child might complain of are pain when swallowing, difficulty swallowing, refusal to eat or drink anything because it’s painful. They may complain of pain on the outside of their neck where their lymph glands are.”
Most sore throats are caused by viruses and will be get better on their own. Dr. Rajapakse says, “90 percent of sore throats are caused by viruses. Those are the most common cause of sore throats. A small percentage of sore throats are caused by the group A strep or strep bacteria, and those are the ones that require treatment with antibiotics. All viral sore throats will get better on their own, and there’s no benefit to taking antibiotics and, in fact, taking antibiotics for them could cause you or your child harm.
More health and medical news on the Mayo Clinic News Network http://newsnetwork.mayoclinic.org/
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