Chapter 15: Earache Assessment & Diagnosis

Earache Assessment & Diagnosis begins by establishing that while acute otitis media (AOM) is the predominant cause of ear inflammation in children, adult earache is frequently attributed to external ear conditions or referred pain from the temporomandibular joint (TMJ), teeth, or cervical spine. The text outlines critical historical risk factors, including recent upper respiratory infections (URI), environmental smoke exposure, daycare attendance, bottle propping, and swimming, all of which contribute to eustachian tube dysfunction or external canal irritation. The diagnostic reasoning process is detailed through focused history questions regarding the onset, duration, and location of pain, as well as the presence of fever, discharge, or hearing loss. The physical examination section emphasizes the importance of inspecting the auricle and mastoid process for signs of cellulitis or mastoiditis, followed by a meticulous otoscopic evaluation to assess the external canal for patency and the tympanic membrane (TM) for color, contour, landmarks, and mobility via pneumatic otoscopy. The chapter thoroughly explains how to interpret tympanometry results and perform tuning fork exams (Weber and Rinne tests) to differentiate between conductive and sensorineural hearing loss. A robust differential diagnosis is presented, contrasting the clinical features of external otitis (swimmer's ear), which presents with canal inflammation and pain on manipulation, against AOM, characterized by a bulging, immobile, and erythematous TM. Other critical conditions discussed include otitis media with effusion (OME), marked by fluid levels or bubbles; cholesteatoma, an epidermal inclusion cyst requiring referral; and malignant otitis externa, a severe infection often seen in immunocompromised or diabetic patients. Finally, the chapter addresses non-otologic causes of ear pain, such as dental malocclusion, TMJ disorders, and cranial nerve neurlagias involving the trigeminal, facial, glossopharyngeal, and vagus nerves.