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Earache

It is also known as OTALGIA. This is the most common complaint found in children and adults. It is not always associated with ear disease. It may be caused by several other conditions, such as impacted teeth, sinus disease, inflamed tonsils and infections in the nose and pharynx.
This may due to diseases of external, middle and inner ear.

Causes:-
External ear-	Foreign body in auditory canal like insect, cotton bud, etc. Impact moisture in auditory canal. Inflammation of external ear (otitis externa) due to infection.
Middle ear-	Infection of middle ear (otitis media). The most common cause is infection of upper respiratory tract. The Eustachian tube which connect the pharynx to middle ear transmits the infection. Mechanical Trauma- barotrauma (often iatrogenic), Eustachian tube obstruction leading to acute otitis media. Allergies. Family history of ear infection.
Ear pain can be referred pain to the ears in five main ways:- Via Trigeminal nerve [cranial nerve V]. Rarely, trigeminal neuralgia can cause otalgia. Via Facial nerve [cranial nerve VII]. This can come from the teeth (most commonly the upper molars, when it will be worse when drinking cold fluids), the temporomandibular joint (due to its close relation to the ear canal), or the parotid gland. Via Glossopharyngeal nerve [cranial nerve IX]. This comes from the oropharynx, and can be due to pharyngitis or tonsillitis, or to carcinoma of the posterior third of the tongue. Via Vagus nerve [cranial nerve X]. This comes from the laryngopharynx in carcinoma of the pyriform fossa or from the esophagus in GERD. Via the second and third cervical vertebrae, C2 and C3. This ear pain is therefore postural.
Psychogenic earache is when no cause to the pain in ears can be found, suggesting a functional origin. The patient in such cases should be kept under observation with periodic re-evaluation.

Symptoms:
1.Otitis externa-
a.the pain is severe in intensity, worsen by pulling and touching ear.
b.Hearing loss.
c.Ringing and buzzing sound in ear.
d.Sensation of fullness in the ear.
e.Swelling of extrnal ear.
f.Thick drainage of ear.
2.Otitis media-
a.Pain in ear.
b.Hearing loss.
c.Plugged or full sensaton in the ear.
d.Fever
e.Discharge from ear that coming out after rupture of eardrum.
f.Ringing and buzzing in the ear.
g.Other symptoms- nausea and vomiting, irritability, etc.

Investigation:
A physician diagnoses otitis externa or otitis media after examining the ear with an instrument called an otoscope. In general, x-rays and other tests are unnecessary.
1.Otoscopy
2.Hearing test for otitis media
3.Laboratory tests in otitis externa

>>Sometimes, a sample of drainage from the ear is sent to the laboratory in an attempt to identify the specific bacteria causing the infection.

>>Sending the sample to the laboratory is not needed in most cases and usually is reserved for infections that do not respond to normal treatment.

Management:
1. If there is a high fever or severe pain for an ear infection or new symptoms appear, like dizziness, severe headache, swelling around the ear, weakness of the face muscles, severe pain suddenly stops; this may be a sign of a ruptured eardrum and symptoms (pain, fever, or irritability) get worse or do not improve within 24 - 48 hours then patient should consult a specialist.
2. Homoeopathy-People who regularly suffer form ear aches and ear infections already know that it is possible for the body to develop immunity to the antibiotics that are regularly prescribed to treat them. They should therefore, turn to homoeopathy for help in treating cases of earache. They will surely be satisfied!
3. Prevention- The following steps can help prevent earaches:

Avoid smoking near children. Smoking has been shown to cause millions of ear infections each year in children.

Prevent outer ear infections by not putting objects in the ear, and drying the ear after bathing or swimming.

Take steps to control allergies. In particular, avoid allergy triggers. Steroid nasal spray may help reduce ear infections. However, over-the-counter sedating antihistamines and decongestants do NOT prevent ear infections.

Please E-mail dr_ramanand@rediffmail.com for any questions/treatment

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