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===MRI===
===MRI===
There are no MRI findings associated with [disease name].
Ear MRI( Magnetic resonance imaging) and referral for nasolaryngoscopymay be helpful in the diagnosis of ear pain in childen in the setting of otalgia with normal ear examination findings and symptoms of or risk factors for tumor<ref name="urlDiagnosis of Ear Pain - American Family Physician3">{{cite web |url=https://www.aafp.org/afp/2008/0301/p621.html#afp20080301p621-b40 |title=Diagnosis of Ear Pain - American Family Physician |format= |work= |accessdate=}}</ref> . Findings on MRI<ref name="pmid29798114">{{cite journal |vauthors=Hao XP, Yang BT, Lei L, Wei XM, Li YX |title=[The characteristics of CT scan and MRI images of middle ear adenomas] |language=Chinese |journal=Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi |volume=31 |issue=21 |pages=1625–1629 |date=November 2017 |pmid=29798114 |doi=10.13201/j.issn.1001-1781.2017.21.001 |url=}}</ref> diagnostic of ear tumor include equal T1 and T2 signals with intensifying in tympanum, , and Long T1 or equal T1 and long T2 signal in mastoid showed obstructive inflammation.


OR
<br />
 
[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===
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].
There are no other imaging findings associated withear pain in children.
 
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===
===Other Diagnostic Studies===

Revision as of 06:52, 25 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

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:[1]
  • primary
  • secondary
  • traumatic
  • Other variants of ear pain in children include[2] 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[3] is Primary otalgia include otitis media and otitis externa[4] 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 [5][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[6]. 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:[7][8]

Auricle:[9]

  • Contusion (auricular hematoma).
  • Infection: Cellulitis, Perichondritis, Herpes zoster oticus (Ramsay Hunt syndrome)[10].
  • Allergic angioedema
  • Juvenile spring eruption (polymorphous light eruption)
  • Environmental injury

Ear canal:

  • Malignant otitis externa [12]
  • Contact dermatitis
  • Furuncle
  • Foreign body
  • Cerumen impaction
  • Tumor

Middle and inner ear:

  • Acute otitis media[13]
  • Complications of acute otitis media: Spontaneous rupture of the tympanic membrane , Mastoiditis, Facial palsy[14], Inner ear infection, Involvement of contiguous structures[15][16][17],
  • Otitis media with effusion
  • Eustachian tube dysfunction
  • Cholesteatoma
  • Blunt or penetrating trauma: Traumatic tympanic membrane perforation, Traumatic disruption of the ossicles or inner ear, [18], Basilar skull fracture.

Secondary otalgia: [19]

  • 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 [ear pain in children] 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 ear pain in children are Allergies or asthma, ear infections[24], Coronary artery disease risk factors, Diabetes or immunocompromise, smoker or negative smoker(tobacco), Unilateral hearing loss, Superior tympanic membrane retraction pocket, otorrhea [25].

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

  • ear pain in children is usually asymptomatic.
  • Symptoms of ear pain in children may include the following:[26]
  • Ear pain, especially when lying down
  • Tugging or pulling at an ear
  • Difficulty sleeping
  • Crying more than usual
  • Acting more irritable than usual
  • Difficulty hearing or responding to sounds
  • Loss of balance
  • Fever of 100 F (38 C) or higher
  • Drainage of fluid from the ear
  • Headache
  • Loss of appetite

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.[27]
  • Physical examination may be remarkable for:[28]
  • 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[29]

  • There are no specific laboratory findings associated with ear pain in children.
  • An elevated concentration of CBC, ESR, and CRP is diagnostic of serious or deep-seated infections, such as mastoiditis, malignant otitis externa, or bacterial meningitis .
  • Other laboratory findings consistent with the diagnosis of ear pain in children include [Bacterial or fungal culture of ear drainage], Blood culture, Lumbar puncture[30][31][32][33][34],and Audiometry.

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 ear pain in children. However, an x-ray may be helpful in the diagnosis of tumors or other structural problems in or adjacent to the ear[35]

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 ear pain in children. However, a CT scan[36] may be helpful in the diagnosis of complications of otitis media in ear pain in children, which include altered mental status in conjunction with cardiovascular instability, fever, focal neurologic findings, meningismus, and/or severe headache, complications, such as venous sinus thrombosis, meningitis, or brain abscess should be suspected.

MRI

Ear MRI( Magnetic resonance imaging) and referral for nasolaryngoscopymay be helpful in the diagnosis of ear pain in childen in the setting of otalgia with normal ear examination findings and symptoms of or risk factors for tumor[37] . Findings on MRI[38] diagnostic of ear tumor include equal T1 and T2 signals with intensifying in tympanum, , and Long T1 or equal T1 and long T2 signal in mastoid showed obstructive inflammation.


Other Imaging Findings

There are no other imaging findings associated withear pain in children.

Other Diagnostic Studies

  • Ear pain in children usually diagnosed using otoscope [39], or tympanometry can be helpful if there is suspicion of middle ear disease:[40]
  • Findings[41] on otoscopic examination include redness, flaking, swelling, or thick discharge[42] 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

  • The mainstay of therapy for ear pain in children over-the-counter drugs like Tylenol(acetaminophen) or ibuprofen (Advil, Motrin) and anesthetic drops, antibiotics for ear infections even its not effective treatment[43]. DIY remedies [44]

Surgery

  • Surgery is the mainstay of therapy for cholesteatoma (Abnormal squamous epithelium) polypoid disease, and infected bone must be removed in order to create a dry, safe ear that is free of infection[45].
  • [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

  • Effective measures for the primary prevention of ear pain in children include Don’t smoke, and avoid secondhand smoke[46],Keep all foreign objects out of your ears always take time to carefully dry your ears after swimming, showering, or bathing, and You can also wear a bathing cap, earplugs, or use custom-fitted swim molds when swimming[47]. Hold a hair drier on a low heat setting at least 12 inches from the ear[48]

References

  1. ↑ "StatPearls". 2020. PMID 31751020 PMID: 31751020 Check |pmid= value (help).
  2. ↑ "UpToDate".
  3. ↑ 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).
  4. ↑ "Synonyms for EARACHE - Thesaurus.net".
  5. ↑ "UpToDate".
  6. ↑ 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).
  7. ↑ "UpToDate".
  8. ↑ 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).
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ 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.
  13. ↑ 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.
  14. ↑ 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.
  15. ↑ 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.
  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. ↑ 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.
  18. ↑ 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.
  19. ↑ 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)
  20. ↑ 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.
  21. ↑ 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.
  22. ↑ 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.
  23. ↑ 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.
  24. ↑ "Risk Factors for Middle Ear Infections | Winchester Hospital".
  25. ↑ "Diagnosis of Ear Pain - American Family Physician".
  26. ↑ "Ear Infection in Children : Symptoms & Risk Factors".
  27. ↑ "UpToDate".
  28. ↑ "UpToDate".
  29. ↑ 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).
  30. ↑ Chun CH, Johnson JD, Hofstetter M, Raff MJ (November 1986). "Brain abscess. A study of 45 consecutive cases". Medicine (Baltimore). 65 (6): 415–31. PMID 3784900.
  31. ↑ Schliamser SE, Bäckman K, Norrby SR (1988). "Intracranial abscesses in adults: an analysis of 54 consecutive cases". Scand J Infect Dis. 20 (1): 1–9. doi:10.3109/00365548809117210. PMID 3363298.
  32. ↑ Nielsen H (May 1983). "Cerebral abscess in children". Neuropediatrics. 14 (2): 76–80. doi:10.1055/s-2008-1059557. PMID 6877531.
  33. ↑ Patir R, Sood S, Bhatia R (1995). "Post-traumatic brain abscess: experience of 36 patients". Br J Neurosurg. 9 (1): 29–35. PMID 7786422.
  34. ↑ Tattevin P, Bruneel F, Clair B, Lellouche F, de Broucker T, Chevret S, Bédos JP, Wolff M, Régnier B (August 2003). "Bacterial brain abscesses: a retrospective study of 94 patients admitted to an intensive care unit (1980 to 1999)". Am J Med. 115 (2): 143–6. doi:10.1016/s0002-9343(03)00292-4. PMID 12893401.
  35. ↑ "Earache & Ear Pain Causes, Treatment, Remedies & Symptoms".
  36. ↑ Britt RH, Enzmann DR (December 1983). "Clinical stages of human brain abscesses on serial CT scans after contrast infusion. Computerized tomographic, neuropathological, and clinical correlations". J Neurosurg. 59 (6): 972–89. doi:10.3171/jns.1983.59.6.0972. PMID 6631519.
  37. ↑ "Diagnosis of Ear Pain - American Family Physician".
  38. ↑ Hao XP, Yang BT, Lei L, Wei XM, Li YX (November 2017). "[The characteristics of CT scan and MRI images of middle ear adenomas]". Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi (in Chinese). 31 (21): 1625–1629. doi:10.13201/j.issn.1001-1781.2017.21.001. PMID 29798114.
  39. ↑ 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).
  40. ↑ "Diagnosis of Ear Pain - American Family Physician".
  41. ↑ "UpToDate".
  42. ↑ 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.
  43. ↑ "Ear infection (middle ear) - Diagnosis and treatment - Mayo Clinic".
  44. ↑ "3 Home Remedies for an Ear Infection – Health Essentials from Cleveland Clinic".
  45. ↑ "UpToDate".
  46. ↑ "Health Effects of Secondhand Smoke | CDC".
  47. ↑ "www.cdc.gov" (PDF).
  48. ↑ "Earache & Ear Pain Causes, Treatment, Remedies & Symptoms".
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