Ear pain in children

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Eman Alademi, M.D.[2]

Synonyms and keywords: Ear pain in kids= earache, aching, ache, earwig, earreach, erg, ericaceae, erse, erica, eruca, erase, earwax, eris, eureka, eros, Erik Weisz, erose, eurasia. Earache � Otitis � Mastoiditis � Tympanic membrane rupture � Cerumen impaction � Foreign body

Historical Perspective

• Ear pan in children was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
• In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
• In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].

Classification

• ear pain in children may be classified according to [classification method] into [number] subtypes/groups:

• primary
• secondary
• traumatic

• Other variants of ear pain in children include Diseases of the auricle , Diseases of the ear canal], Secondary otalgia, Diseases of the middle and inner ear, and Traumatic injuries to the ear.

Pathophysiology

• The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
• The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
• On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
• On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

Causes

The most common cause of ear pain in children is Primary otalgia include otitis media and otitis externa include:

1.Diseases of the auricle like: Cellulitis of the auricle, Perichondritis,Herpes zoster oticus, Local allergic reaction (bug bite), Contact dermatitis, Sunburn, Frostbite.

2.Diseases of the ear canal like:Otitis externa( Bacterial, Fungal,Malignant otitis externa), Furunculosis, Cerumen impaction, Foreign bodies, Granuloma,Malignant tumor, Contact dermatitis, Eczema.

3.Diseases of the middle and inner ear like: Acute otitis media, Eustachian tube dysfunction, Otitis media with effusion, Otitis media with perforation, Otitis media with tympanostomy tubes, Myringitis, Cholesteatoma, Malignant tumor, Complications of otitis media( Mastoiditis, Meningitis, Brain abscess, Venous sinus thrombosis, Inner ear infection, Facial nerve palsy).

Less common causes of [ear pain in children] is secondary otalgia include [temporomandibular joint syndrome],[ pharyngitis], stomatitis, Auricular lymphadenopathy or lymphadenitis, Sinusitis (maxillary),Parotitis,Facial nerve palsy, Psychogenic, cervical spine arthritis, and dental infections but its more common in adults than children. or Traumatic injuries to the ear Abrasions or lacerations, Auricular hematoma, Traumatic perforation of the TM, Disruption of the ossicles, Hemotympanum (blunt or barotrauma), Basilar skull fracture, Associated intracranial injury, Inner ear injury (blunt or barotrauma).

Differentiating ear pain in children from other Diseases

Ear pain in children must be differentiated from:

Auricle:

• Contusion (auricular hematoma).

• Infection: Cellulitis, Perichondritis, Herpes zoster oticus (Ramsay Hunt syndrome).

• Allergic angioedema

• Juvenile spring eruption (polymorphous light eruption)

• Environmental injury

Ear canal:

• Otitis externa

• Malignant otitis externa

• Contact dermatitis

• Furuncle

• Foreign body

• Cerumen impaction

• Tumor

Middle and inner ear:

• Acute otitis media

• Complications of acute otitis media: Spontaneous rupture of the tympanic membrane , Mastoiditis, Facial palsy, Inner ear infection, Involvement of contiguous structures,

• Otitis media with effusion

• Eustachian tube dysfunction

• Cholesteatoma

• Blunt or penetrating trauma: Traumatic tympanic membrane perforation, Traumatic disruption of the ossicles or inner ear, , Basilar skull fracture.

Secondary otalgia:

• Auricular lymphadenopathy or lymphadenitis

• Parotitis,

• Temporomandibular joint dysfunction syndrome,

• Facial nerve (Bell's) palsy,

• Oropharyngeal infections,

• Sinusitis,

• Cervical spine injury

Epidemiology and Demographics

• The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
• In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].

Age

• Patients of all age groups may develop [disease name].

• [Disease name] is more commonly observed among patients aged [age range] years old.
• [Disease name] is more commonly observed among [elderly patients/young patients/children].

Gender

• [Disease name] affects men and women equally.

• [Gender 1] are more commonly affected with [disease name] than [gender 2].
• The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.

Race

• There is no racial predilection for [disease name].

• [Disease name] usually affects individuals of the [race 1] race.
• [Race 2] individuals are less likely to develop [disease name].

Risk Factors

• Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

Natural History, Complications and Prognosis

• The majority of patients with [disease name] remain asymptomatic for [duration/years].
• Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
• If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
• Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
• Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].

Diagnosis

Diagnostic Criteria

• The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:

• [criterion 1]
• [criterion 2]
• [criterion 3]
• [criterion 4]

Symptoms

• [Disease name] is usually asymptomatic.
• Symptoms of [disease name] may include the following:

• [symptom 1]
• [symptom 2]
• [symptom 3]
• [symptom 4]
• [symptom 5]
• [symptom 6]

Physical Examination

• Patients with [disease name] usually appear [general appearance].
• Physical examination may be remarkable for:

• [finding 1]
• [finding 2]
• [finding 3]
• [finding 4]
• [finding 5]
• [finding 6]

Laboratory Findings

imaging studies; and consultation with an otolaryngologist

• There are no specific laboratory findings associated with [disease name].

• A [positive/negative] [test name] is diagnostic of [disease name].
• An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
• Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

Electrocardiogram

There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

X-ray

There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

CT scan

There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

MRI

There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Other Imaging Findings

There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

• Ear pain in children usually diagnosed using otoscope.
• Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

• There is no treatment for [disease name]; the mainstay of therapy is supportive care.

• The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
• [Medical therapy 1] acts by [mechanism of action 1].
• Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

Surgery

• Surgery is the mainstay of therapy for [disease name].
• [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
• [Surgical procedure] can only be performed for patients with [disease stage] [disease name].

Prevention

• There are no primary preventive measures available for [disease name].

• Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

• Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].