Painful situationsSudden headache Back pain (low back pain) Sciatica (lumbar disc herniation) Stiff neck and neck pain The "whiplash" Chest pain Abdominal pain Ear pain Sore throat
- Sudden headache
- Back pain (low back pain)
- Sciatica (lumbar disc herniation)
- Stiff neck and neck pain
- The "whiplash"
- Chest pain
- Abdominal pain
- Ear pain
- Ear pain caused by infections
- Sore throat
Ear pain (or ear pain) is a fairly frequent disorder especially in children and is mostly associated with infections of the external ear canal and middle ear. Other causes may be oro-pharyngeal pathologies that manifest with a reflex pain in the ear, trauma from foreign bodies, barotraumas (injuries related to pressure imbalances), allergies, diseases of dental relevance or problems related to the temporomandibular joint- mandibular.
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Ear pain caused by infections
Depending on the location of the infection, the two most common forms of otitis are identified: external otitis and otitis media.
External otitis This form of otitis, which often affects teenagers and young people, is mainly determined by bacteria and more rarely by fungi (otomycosis). A frequent way of getting the infection is swimming in polluted water (the so-called swimmer's ear).
Predisposing factors can be excessive moisture or dryness of the external auditory canal, a tortuous form of the duct, which makes it difficult to eliminate earwax, or diseases such as diabetes, allergies and psoriasis. Even trauma due to the insertion of foreign bodies (for example cotton swabs) can irritate the skin and cause inflammation. The establishment of an external ear infection is favored by any condition that increases the humidity of the duct and alters its physiological defense and self-cleaning mechanisms. In such situations the earwax accumulates and tends to absorb the water that penetrates from the outside, favoring the maceration of the skin and the consequent establishment of the germs. To prevent the appearance of external otitis it is advisable to dry your ears well and use earplugs before diving.
External otitis occurs with discomfort, itching and reduced hearing (hearing loss). Upon physical examination, the skin and the pavilion of the ear may appear red and with an appearance similar to that of an eczema; there may also be a yellowish discharge (otorrhea). On palpation of the external ear the pain increases. The diagnosis is made by the doctor, who can collect the secretion material and have it cultured to identify the germ. Therapy consists of treating the infection, cleaning the ear canal and administering topical antibiotic-based drugs (if the cause is bacterial) and corticosteroids. It is also important to remember that otomycosis (fungal infection) is often misunderstood or secondary to the prolonged use of antibiotic-cortisone mixtures in the ear canal. The therapy is based, in this case, on abundant washes and on the application of local antifungal drugs.
Otitis media Consists of an inflammatory process affecting the middle ear characterized by the presence of transudate (or exudate) in the tympanic case. The most probable cause is obstruction of the Eustachian tube. This obstruction can be due either to mechanical reasons (such as hypertrophy of the adenoids or edema of the nasopharynx) or to structural and functional reasons of the tuba. This obstacle to the aeration of the middle ear causes a collection of exudate inside it, thus favoring colonization by bacteria from infected tissues from the nasopharynx. All forms of acute otitis media must be recognized in time and treated in the most appropriate way to avoid permanent hearing impairment. It is good practice to carry out the audiometric and impedance test at the end of the treatment to exclude the presence of sequelae.
- Acute catarrhal otitis media: it is an inflammation of the middle ear with the presence of mucous or serous fluid due to inflammatory processes of the nasopharynx. In children, catarrhal otitis media is mostly linked to an adenoiditis which causes mechanical tubal occlusion. In this case both ears are frequently affected and nasal breathing is reduced. In adults, on the other hand, otitis media can be secondary to inflammatory processes of the upper airways, such as tracheobronchitis or sinusitis, and can be unilateral. Typical symptoms are hearing loss, a sense of muffling and ear pain. Symptomatic therapy is aimed at improving obstruction and reventilation of the middle ear and consists in the application of decongestants, topical and oral, antihistamines and secretolics.
- Acute purulent otitis media: it is an acute bacterial otitis that mainly affects children between 2 and 4 years of age and can accompany exanthematic diseases (scarlet fever, measles, chicken pox, etc.). Also in this case the aeration of the middle ear is prevented by the obstruction of the auditory tube, which favors the implantation of bacteria from the nasopharynx. The infection can rarely be imported by blood (from the sngue) or pass through a previous perforation of the tympanic membrane. There are several evolutionary stages: 1) the inflammatory stage, characterized by the formation of serum-fibrinous fluid in the tympanic cavity which exerts pressure on the tympanic membrane with increasingly severe otalgia and hearing loss. In this phase, after an accurate diagnosis by the doctor, the therapy consists in the application of nasal and oral decongestants to resolve the tubal obstruction and to guarantee adequate drainage. Depending on the needs, analgesics and antipyretics may be useful; 2) the suppurative stage, which occurs when the exudate becomes purulent; this phase involves the spontaneous rupture of the tympanic membrane and the escape of a yellowish-green liquid. In this situation pain decreases rapidly. The therapy consists in the use of nasal decongestants and in aerosol therapy to favor the reopening of the tuba. At this stage of the disease, a thorough objective examination of the nasopharynx and nasal cavities is necessary; 3) the resolution: if there are no complications, otitis resolves with the scarring of the perforated area and the hearing loss resolves within 2-3 weeks. A rare but serious complication is mastoiditis, with possible involvement of the venous sinuses and meninges.
- Bullous hemorrhagic myringitis (or acute hemorrhagic otitis media): this is an inflammation of the tympanic membrane mostly of viral origin, which occurs in conjunction with diseases such as flu, measles, mumps or mononucleosis. The characteristic symptoms of the underlying disease are associated with intense ear pain, fever and bloody otorrhagia. With adequate medical therapy, this form of otitis heals without leaving sequelae.
- Acute tubal otitis: it is a pathology that affects the nasopharynx. Predisposing factors are the posterior deviation of the nasal septum, acute sinusitis, allergic rhinitis, stenosis (narrowing) of the Eustachian tube, tumors of the nasopharynx and, in children, adenoiditis. The disease manifests itself with a feeling of discomfort or of a foreign body in the external auditory canal and of muffling; there is no actual pain. The therapy consists in restoring the ventilation of the middle ear, therefore in the application of decongestant drugs, and in the surgical removal of the adenoids blocking the outlets of the Eustachian tube.
- Acute otitis media in infants: the relatively frequent onset of otitis media in infants is due to the particular anatomical shape of the Eustachian tube in this age, which facilitates the regurgitation of milk in the tympanic case. Symptomatology can be blurred by the presence of vomiting, diarrhea, agitation and insomnia. The baby often brings his hand to his ear and interrupts the feeding with the tears after the first sips. The therapy involves the use of antibiotics, but the parents can temporarily calm the pain by applying warm gauze to the ear and instilling a few drops of warm glycerin in the ear.
- Barotrauma otitis: this form of otitis is caused by a sudden increase in pressure on the membrane of the eardrum, following pressure changes from rapid changes in altitude, for example during landing or take-off by plane or in scuba diving. Under normal conditions this pressure variation is compensated by the passage of air in the middle ear from the pharynx through the Eustachian tube. When the compensation is hindered by an inflamed or edematous mucosa or by another obstructive cause, the pressure of the middle ear is reduced compared to the environmental one, giving rise to an inflammatory process of the tympanic mucosa that involves the accumulation of liquid and, in cases more serious, the rupture of the tympanic membrane. Symptoms are ear pain, tinnitus and mild hearing loss. To maintain the patency of the tuba it is good practice to chew and swallow during the landing and take-off phases. Therapy consists in the use of pain relievers, decongestants and, rarely, antibiotics.
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