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===Physical Examination===
===Physical Examination===


*Patients with [disease name] usually appear [general appearance].
*Patients of child  with ear pain  usually appear either stable with discomfort and holding their ear and crying, Younger infants or toddlers may be fussy and difficult to console. or  with abnormal vital signs like ear pain, epidural hematoma, and  abnormal mental status due to brain infection or traumatic injury.<ref name="urlUpToDate5">{{cite web |url=https://www.uptodate.com/contents/evaluation-of-earache-in-children?search=Pathophysiology%20ear%20pain&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2 |title=UpToDate |format= |work= |accessdate=}}</ref>
*Physical examination may be remarkable for:
*Physical examination may be remarkable for:


Revision as of 09:56, 18 January 2021

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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[1]= 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[2]

Overview

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:[3]
  • primary
  • secondary
  • traumatic
  • Other variants of ear pain in children include[4] 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[5] is Primary otalgia include otitis media and otitis externa[6] 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 [7][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[8]. 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:[9][10]

Auricle:[11]

  • Contusion (auricular hematoma).
  • Infection: Cellulitis, Perichondritis, Herpes zoster oticus (Ramsay Hunt syndrome)[12].
  • Allergic angioedema
  • Juvenile spring eruption (polymorphous light eruption)
  • Environmental injury

Ear canal:

  • Malignant otitis externa [14]
  • Contact dermatitis
  • Furuncle
  • Foreign body
  • Cerumen impaction
  • Tumor

Middle and inner ear:

  • Acute otitis media[15]
  • Complications of acute otitis media: Spontaneous rupture of the tympanic membrane , Mastoiditis, Facial palsy[16], Inner ear infection, Involvement of contiguous structures[17][18][19],
  • Otitis media with effusion
  • Eustachian tube dysfunction
  • Cholesteatoma
  • Blunt or penetrating trauma: Traumatic tympanic membrane perforation, Traumatic disruption of the ossicles or inner ear, [20], Basilar skull fracture.

Secondary otalgia: [21]

  • Auricular lymphadenopathy or lymphadenitis
  • 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 of child with ear pain usually appear either stable with discomfort and holding their ear and crying, Younger infants or toddlers may be fussy and difficult to console. or with abnormal vital signs like ear pain, epidural hematoma, and abnormal mental status due to brain infection or traumatic injury.[26]
  • Physical examination may be remarkable for:
  • abnormal vital signs due to serious infection, like meningitis, sepsis, or serious traumatic injury, like epidural hematoma.
  • holding their ear and crying in sever otitis media or externa.
  • moderate to severe hearing loss
  • traumatic injury like lacerations, ecchymoses, fluctuant hematomas, or swelling.
  • periorbital ecchymoses Signs of basilar skull fracture.
  • Battle sign (ecchymosis overlying the mastoid bone)
  • diffuse redness and swelling of the external ear due to indicate infection or local allergic reaction
  • Protrusion of the ear from the side of the head due to either allergic or infectious inflammation of the pinna or mastoiditis
  • Pre- or postauricular lymphadenopathy presence of any fluctuance and overlying redness or swelling

Laboratory Findings

imaging studies; and consultation with an otolaryngologist[27]

  • 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[28]:
  • Findings[29] on otoscopic examination include redness, flaking, swelling, or thick discharge[30] of ear canal, presence of masses, foreign bodies, bullae, or eczematous changes, and the TM appears thickened or cloudy, or if air bubbles are evident behind the TM, a middle ear effusion should be suspected, tense, pus-filled bullae may be seen in AOM(Auditory canal and middle ear), Redness or bullae of the TM without evident fluid in the middle ear suggests isolated myringitis, Perforations of the TM, inserted tympanostomy tube can see location and patency should be assessed, In cases of trauma, hemotympanum may be noted. Hemotympanum is characterized by a red or purple effusion, which may occupy the entire middle ear space or may appear as an air-fluid level.

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].

References

  1. ↑ "Synonyms for EARACHE - Thesaurus.net".
  2. ↑ "Redirecting".
  3. ↑ "StatPearls". 2020. PMID 31751020 PMID: 31751020 Check |pmid= value (help).
  4. ↑ "UpToDate".
  5. ↑ Ely JW, Hansen MR, Clark EC (2008). "Diagnosis of ear pain". Am Fam Physician. 77 (5): 621–8. PMID 18350760 PMID: 18350760 Check |pmid= value (help).
  6. ↑ "Synonyms for EARACHE - Thesaurus.net".
  7. ↑ "UpToDate".
  8. ↑ Earwood JS, Rogers TS, Rathjen NA (2018). "Ear Pain: Diagnosing Common and Uncommon Causes". Am Fam Physician. 97 (1): 20–27. PMID 29365233 : 29365233 Check |pmid= value (help).
  9. ↑ "UpToDate".
  10. ↑ Bandúrová V, Plzák J, Bouček J (2019). "Differential diagnosis of ear pain". Cas Lek Cesk. 158 (6): 231–234. PMID 31931581 PMID: 31931581 Check |pmid= value (help).
  11. ↑ Ghanem T, Rasamny JK, Park SS (2005). "Rethinking auricular trauma". Laryngoscope. 115 (7): 1251–5. doi:10.1097/01.MLG.0000165377.92622.EF. PMID 15995516.
  12. ↑ Kansu L, Yilmaz I (2012). "Herpes zoster oticus (Ramsay Hunt syndrome) in children: case report and literature review". Int J Pediatr Otorhinolaryngol. 76 (6): 772–6. doi:10.1016/j.ijporl.2012.03.003. PMID 22445801.
  13. ↑ Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA; et al. (2014). "Clinical practice guideline: acute otitis externa". Otolaryngol Head Neck Surg. 150 (1 Suppl): S1–S24. doi:10.1177/0194599813517083. PMID 24491310.
  14. ↑ Rubin J, Yu VL, Stool SE (1988). "Malignant external otitis in children". J Pediatr. 113 (6): 965–70. doi:10.1016/s0022-3476(88)80564-x. PMID 3142986.
  15. ↑ Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA; et al. (2013). "The diagnosis and management of acute otitis media". Pediatrics. 131 (3): e964–99. doi:10.1542/peds.2012-3488. PMID 23439909.
  16. ↑ Mattos JL, Colman KL, Casselbrant ML, Chi DH (2014). "Intratemporal and intracranial complications of acute otitis media in a pediatric population". Int J Pediatr Otorhinolaryngol. 78 (12): 2161–4. doi:10.1016/j.ijporl.2014.09.032. PMID 25447953.
  17. ↑ Wu JF, Jin Z, Yang JM, Liu YH, Duan ML (2012). "Extracranial and intracranial complications of otitis media: 22-year clinical experience and analysis". Acta Otolaryngol. 132 (3): 261–5. doi:10.3109/00016489.2011.643239. PMID 22224578.
  18. ↑ Mattos JL, Colman KL, Casselbrant ML, Chi DH (2014). "Intratemporal and intracranial complications of acute otitis media in a pediatric population". Int J Pediatr Otorhinolaryngol. 78 (12): 2161–4. doi:10.1016/j.ijporl.2014.09.032. PMID 25447953.
  19. ↑ Zapalac JS, Billings KR, Schwade ND, Roland PS (2002). "Suppurative complications of acute otitis media in the era of antibiotic resistance". Arch Otolaryngol Head Neck Surg. 128 (6): 660–3. doi:10.1001/archotol.128.6.660. PMID 12049560.
  20. ↑ Hurtado TR, Zeger WG (2004). "Hemotympanums secondary to spontaneous epistaxis in a 7-year-old". J Emerg Med. 26 (1): 61–3. doi:10.1016/j.jemermed.2003.05.001. PMID 14751480.
  21. ↑ Conover K (2013). "Earache". Emerg Med Clin North Am. 31 (2): 413–42. doi:10.1016/j.emc.2013.02.001. Unknown parameter |*pmid= ignored (help)
  22. ↑ Battle S, Laudenbach J, Maguire JH (2007). "Influenza parotitis: a case from the 2004 to 2005 vaccine shortage". Am J Med Sci. 333 (4): 215–7. doi:10.1097/MAJ.0b013e31803b92c4. PMID 17435413.
  23. ↑ Francis CL, Larsen CG (2014). "Pediatric sialadenitis". Otolaryngol Clin North Am. 47 (5): 763–78. doi:10.1016/j.otc.2014.06.009. PMID 25128215.
  24. ↑ Stong BC, Sipp JA, Sobol SE (2006). "Pediatric parotitis: a 5-year review at a tertiary care pediatric institution". Int J Pediatr Otorhinolaryngol. 70 (3): 541–4. doi:10.1016/j.ijporl.2005.08.001. PMID 16154645.
  25. ↑ Tucci FM, Roma R, Bianchi A, De Vincentiis GC, Bianchi PM (2019). "Juvenile recurrent parotitis: Diagnostic and therapeutic effectiveness of sialography. Retrospective study on 110 children". Int J Pediatr Otorhinolaryngol. 124: 179–184. doi:10.1016/j.ijporl.2019.06.007. PMID 31202035.
  26. ↑ "UpToDate".
  27. ↑ Ely JW, Hansen MR, Clark EC (2008). "Diagnosis of ear pain". Am Fam Physician. 77 (5): 621–8. PMID 18350760 PMID: 18350760 Check |pmid= value (help).
  28. ↑ Siddiq MA, Samra MJ (2008). "Otalgia". BMJ. 336 (7638): 276–7. doi:10.1136/bmj.39364.643275.47. PMC 2223060. PMID 18245001 PMID: 18245001 Check |pmid= value (help).
  29. ↑ "UpToDate".
  30. ↑ Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA, Huang WW, Haskell HW, Robertson PJ (February 2014). "Clinical practice guideline: acute otitis externa". Otolaryngol Head Neck Surg. 150 (1 Suppl): S1–S24. doi:10.1177/0194599813517083. PMID 24491310.
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