Otalgia differential diagnosis: Difference between revisions

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==Overview==
==Overview==
Based on the pain originates,differential diagnosis can be divided into primary and secondary categories.The causes of the Primary otalgia include,infectious,mechanical,neoplastic and inflammatory.Secondary otalgia originates other organ system. Most of the secondary causes related to head and neck.
Based on the pain originates,differential diagnosis can be divided into primary and secondary categories.The causes of the Primary [[otalgia]] include,[[infectious]],mechanical,[[Neoplastic disease|neoplastic]] and [[inflammatory]].Secondary otalgia originates other organ system. Most of the secondary causes related to head and neck.


==Differentiating Otalgia from other Diseases==
==Differentiating Otalgia from other Diseases==
 
Based on the pain originates,differential diagnosis can be divided into primary and secondary categories.The causes of the Primary [[otalgia]] include,[[infectious]],mechanical,[[Neoplastic disease|neoplastic]] and [[inflammatory]].Secondary [[otalgia]] originates other organ system. Most of the secondary causes related to head and neck.<ref name="pmid18245001">{{cite journal| author=Siddiq MA, Samra MJ| title=Otalgia. | journal=BMJ | year= 2008 | volume= 336 | issue= 7638 | pages= 276-7 | pmid=18245001 | doi=10.1136/bmj.39364.643275.47 | pmc=2223060 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18245001  }} </ref><ref name="pmid28846338">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28846338 | doi= | pmc= | url= }} </ref>


===Differentiating otalgia from other diseases on the basis of primary and secondary causes===
===Differentiating otalgia from other diseases on the basis of primary and secondary causes===
 
<ref name="pmid28846338">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28846338 | doi= | pmc= | url= }} </ref><ref name="pmid18245001">{{cite journal| author=Siddiq MA, Samra MJ| title=Otalgia. | journal=BMJ | year= 2008 | volume= 336 | issue= 7638 | pages= 276-7 | pmid=18245001 | doi=10.1136/bmj.39364.643275.47 | pmc=2223060 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18245001  }} </ref>
 
{| class="wikitable"
{|
|+
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |symptoms
! colspan="7" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |physical examination
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
|-
|-
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
|+
 
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Otitis media]]
|[[otalgia]], hearing loss,new onset of [[otorrhea]] not caused by [[otitis externa]]
|Bulging [[tympanic membrane]],Middle ear effusion
|-
|-
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
 
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Otitis externa]]
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
|[[otalgia]], [[pruritus]], discharge, and [[hearing loss]]
|-
|Tenderness with tragal pressure,edema and erythema of ear canal
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptom 1
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptom 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptom 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam 1
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 3
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Otitis Media
 
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Myringitis bullosa|Myringitis]]
| style="background: #F5F5F5; padding: 5px;" |
|[[otalgia]]+/-, ear discharge
| style="background: #F5F5F5; padding: 5px;" |
|Serous liquid-filled blisters on the [[tympanic membrane]]
| style="background: #F5F5F5; padding: 5px;" |
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|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Otitis Externa
 
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Eustachian tube dysfunction]]
| style="background: #F5F5F5; padding: 5px;" |
|[[otalgia]], a sensation of ear fullness or pressure, [[hearing loss]],  [[tinnitus]],autophony
| style="background: #F5F5F5; padding: 5px;" |
|Retracted  [[tympanic membrane]] , short process is more prominent, [[manubrium]] (or handle) of the [[malleus]] appears shorter
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|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Myringitis
 
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cerumen impaction|Foreign body,cerumen impaction]]
| style="background: #F5F5F5; padding: 5px;" |
|[[otalgia]],[[hearing loss]], sense of fullness,Insects, small objects Commonly occurs in children
| style="background: #F5F5F5; padding: 5px;" |
|Foreign body visible in ear canal[[Cerumen|, cerumen]]
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|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diseases
!Symptom 1
! colspan="1" rowspan="1" |Symptom 2
!Symptom 3
!Physical exam 1
! colspan="1" rowspan="1" |Physical exam 2
!Physical exam 3
!Lab 1
!Lab 2
!Lab 3
!Imaging 1
!Imaging 2
!Imaging 3
!Histopathology
|'''Gold standard'''
!Additional findings
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Eustachian tube dysfunction
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Cerumen impaction
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Barotrauma
| style="background: #F5F5F5; padding: 5px;" |
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|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;"|Cholesteatoma
| style="background: #F5F5F5; padding: 5px;" |
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|-
| style="background: #DCDCDC; padding: 5px; text-align: center;"|Wegener granulomatosis
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Barotrauma]]
|Pain onset during descent of airplane or while scuba diving
|[[Tympanic membrane]] hemorrhage Serous or hemorrhagic middle ear fluid
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;"|Sinusitis
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cholesteatoma]]
|painless [[otorrhea]], [[Hearing loss]],[[Dizziness|dizzinesss]]
|white keratinaceous debris  in the posterosuperior [[tympanic membrane]] quadrant
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;"|Temporomandibular joint disease
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Wegener's granulomatosis|Wegener granulomatosis]]
|[[Arthralgia]] ,[[Hearing loss]], [[Myalgia|Myalgias]] ,Oral or nasal ulcers ,[[Otorrhea]] ,[[Rhinorrhea]]
|Often causes [[Otitis media|chronic otitis media]] or serous otitis
|
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;"|Dental caries or other dental pathology
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sinusitis]]
|Nasal congestion, Pain in [[Maxillary|maxillary sinuses]]
|Nasal congestion Tender over [[maxillary]] sinuses
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;"|dental caries or other dental pathology
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Temporomandibular joint]]
|Pain or [[crepitus]] with talking or chewing
|Tender [[TMJ]] Crepitus or clicking on motion of [[mandible]] May have restricted jaw movement
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;"|Neuralgia
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Dental pathology
|May have dental complaints or history of dental disorders
|Caries [[Abscess]], [[Gingivitis]] ,Facial swelling ,Teeth tender to percussion
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;"|pharyngitis
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Cervical [[lymphadenopathy]]
|May have recent upper respiratory infection or scalp lesion
|Tender cervical or periauricular lymph nodes
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;"|Myofascial pain
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[pharyngitis]]
|Often accompanied by [[sore throat]]
|[[Pharyngeal]] or [[Tonsillar Disease|tonsillar]] erythema Swelling Exudate
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;"|Myocardial infarction
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[myocardial infarction]]
|Cardiac risk factors
|Usually none
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;"|Gastroesophageal reflux disease (GERD)
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Gastroesophageal reflux disease|Gastroesophageal reflux disease (GERD)]]
|[[Heartburn]] ,Acid reflux
|Usually none
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| style="background: #DCDCDC; padding: 5px; text-align: center;"|Idiopathic or psychogenic
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Idiopathic or [[psychogenic]]
|Variable,History of [[depression]] or [[anxiety]]
|Normal,Blunted affect Depressed mood
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Latest revision as of 18:41, 28 January 2021

Overview

Based on the pain originates,differential diagnosis can be divided into primary and secondary categories.The causes of the Primary otalgia include,infectious,mechanical,neoplastic and inflammatory.Secondary otalgia originates other organ system. Most of the secondary causes related to head and neck.

Differentiating Otalgia from other Diseases

Based on the pain originates,differential diagnosis can be divided into primary and secondary categories.The causes of the Primary otalgia include,infectious,mechanical,neoplastic and inflammatory.Secondary otalgia originates other organ system. Most of the secondary causes related to head and neck.[1][2]

Differentiating otalgia from other diseases on the basis of primary and secondary causes

[2][1]

Diseases symptoms physical examination
Otitis media otalgia, hearing loss,new onset of otorrhea not caused by otitis externa Bulging tympanic membrane,Middle ear effusion
Otitis externa otalgia, pruritus, discharge, and hearing loss Tenderness with tragal pressure,edema and erythema of ear canal
Myringitis otalgia+/-, ear discharge Serous liquid-filled blisters on the tympanic membrane
Eustachian tube dysfunction otalgia, a sensation of ear fullness or pressure, hearing loss, tinnitus,autophony Retracted tympanic membrane , short process is more prominent, manubrium (or handle) of the malleus appears shorter
Foreign body,cerumen impaction otalgia,hearing loss, sense of fullness,Insects, small objects Commonly occurs in children Foreign body visible in ear canal, cerumen
Barotrauma Pain onset during descent of airplane or while scuba diving Tympanic membrane hemorrhage Serous or hemorrhagic middle ear fluid
Cholesteatoma painless otorrhea, Hearing loss,dizzinesss white keratinaceous debris in the posterosuperior tympanic membrane quadrant
Wegener granulomatosis Arthralgia ,Hearing loss, Myalgias ,Oral or nasal ulcers ,Otorrhea ,Rhinorrhea Often causes chronic otitis media or serous otitis
Sinusitis Nasal congestion, Pain in maxillary sinuses Nasal congestion Tender over maxillary sinuses
Temporomandibular joint Pain or crepitus with talking or chewing Tender TMJ Crepitus or clicking on motion of mandible May have restricted jaw movement
Dental pathology May have dental complaints or history of dental disorders Caries Abscess, Gingivitis ,Facial swelling ,Teeth tender to percussion
Cervical lymphadenopathy May have recent upper respiratory infection or scalp lesion Tender cervical or periauricular lymph nodes
pharyngitis Often accompanied by sore throat Pharyngeal or tonsillar erythema Swelling Exudate
myocardial infarction Cardiac risk factors Usually none
Gastroesophageal reflux disease (GERD) Heartburn ,Acid reflux Usually none
Idiopathic or psychogenic Variable,History of depression or anxiety Normal,Blunted affect Depressed mood

References

  1. ↑ 1.0 1.1 Siddiq MA, Samra MJ (2008). "Otalgia". BMJ. 336 (7638): 276–7. doi:10.1136/bmj.39364.643275.47. PMC 2223060. PMID 18245001.
  2. ↑ 2.0 2.1 "StatPearls". 2020. PMID 28846338.

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