EARDRUM, PERFORATED
near the ear. Earache is an extremely
common symptom, especially in infan-
cy and childhood.
CAUSES
A frequent cause of earache is acute
oti-
tis media
(infection of the middle ear),
w hich occurs most commonly in young
children and results in severe, stabbing
pain. There may also be loss of hearing
and a raised temperature.
Another common cause of earache is
otitis externa
(inflammation of the ear
canal), w hich is often caused by infec-
tion. Infection
can affect the whole
canal, or it may be localized, sometimes
taking the form of a boil or abscess.
The earache may be accompanied by
irritation in the ear canal and a dis-
charge of
pus
.
Intermittent earache may also occur
in people w ith dental problems,
tonsil-
litis
,
throat cancer (see
pharynx, cancer
of
) ,
pain in the jaw or neck muscles,
and other disorders affecting areas near
the ear. Earache in such cases occurs
because the ear and nearby areas are
supplied by the same nerves; the pain is
said to be “referred” to the ear.
DIAGNOSIS AND TREATMENT
To determine the cause of earache, the
ear is inspected (see
ear, examination of
) .
The mouth, throat, and teeth may also
be examined.
Analgesic drugs
(painkillers) may be
prescribed to relieve the pain. Other
treatment depends on the underlying
cause of the earache.
Antibiotic drugs
may be prescribed for an infection. Pus
in the outer ear may be removed by
suction. Pus in the middle ear may be
drained through a hole in the eardrum,
a procedure known as
myringotomy
.
ear, cauliflower
See
cauliflower ear.
ear, discharge from
Also called otorrhoea, emission of fluid
from the ear. Not all discharge is the
same; it may be watery or thick, clear or
coloured,
odourless or foul-smelling,
and intermittent or continuous.
CAUSES
A discharge from the ear may be due
to an outer-ear infection (see
otitis ex-
terna
) .
It may also follow perforation of
the eardrum (see
eardrum, perforated
),
w hich is usually due to a middle-ear
infection (see
otitis media
) .
Rarely, after
a skull fracture (see
skull, fracture of
),
cerebrospinal fluid
or blood may be dis-
charged from the ear.
DISORDERSOFTHE EAR
The
ear
is susceptible to many disorders,
some of which can lead to
deafness.
Congenitaldefects
In rare cases, the ear canal,
ossicles
(small bones in the middle ear), or
pinna
(visible part of the ear) are absent
or deformed at birth.
Rubella
(German
measles) in early pregnancy can
damage the baby’s developing ear,
leading to deafness. Most cases of
congenital
sensorineural deafness
(deafness due to problems with the
inner ear, nerves, or the brain’s auditory
area) are genetic.
Infection
Infection is the most common cause of
ear disorders. Infection in the ear canal
leads to
otitis externa;
in the middle ear,
it causes
otitis
media.This can lead to
perforation of the eardrum (see
eardrum, perforated
).
Glue ear
(buildup
of fluid in the middle ear), often due
to infection, is the most common cause
of childhood hearing difficulties.Viral
infection of the inner ear may cause
labyrinthitis
with severe
vertigo
or
sudden hearing loss.
Injury
Cauliflower ear
occurs as the result of one
major or several minor injuries to the
pinna. Perforation of the eardrum can
result from poking objects into the ear
or from loud noise. Prolonged exposure
to loud noise can cause
tinnitus
(noises
within the ear) and/or deafness.
Pressure changes associated with flying
or scuba diving can also cause minor
damage (see
barotrauma
).
Tumours
Acoustic neuroma
is a rare, noncancerous
tumour of the
acoustic nerve
that may
press on structures in the ear to cause
deafness, tinnitus, and problems with
balance. In
cholesteatoma,
skin cells
accumulate in the middle ear.
Obstruction
Obstruction of the ear canal is often due
to
earwax,
although in small children,
an object may have been pushed into
the ear (see
ear, foreign body in
).
Other disorders
In
otosclerosis,
a hereditary condition,
a bone in the middle ear becomes
immobilized, causing deafness.
Meniere's
disease
is a rare condition in which
deafness, vertigo, and tinnitus occur
due to buildup of fluid in the inner ear.
Progressive, age-related hearing loss is a
condition known as
presbyacusis
.
Certain drugs, such as
aminoglycoside
drugs
and some
diuretic drugs,
can also
damage ear function.
INVESTIGATION
Hearing and balance are explored
using
hearing tests, caloric tests,
and
electronystagmography.The
ear canal and
eardrum are viewed with an
otoscope.
E
DIAGNOSIS AND TREATMENT
A swab of the discharge may be taken
and sent to a laboratory for analysis to
identify the cause of any infection.
Hear-
ing tests
may also be performed.
X-rays
of the bones of the skull w ill be taken
if there has been a
head injury
or if a
serious type of middle-ear infection is
suspected from the symptoms.
Treatment depends on the cause and
usually includes
antibiotic drugs
.
eardrum
The circular membrane that separates
the outer
ear
from the middle ear. The
eardrum vibrates in response to sound
waves, conducting the sound to the inner
ear through the
ossicles
(the three small
bones in the middle ear).
eardrum, perforated
The rupture or erosion of the
eardrum
.
Perforation of the eardrum can cause
brief, intense pain. There may also be
slight bleeding, a discharge from the
ear
(see
ear, discharge from
),
and a
reduction in hearing.
CAUSES
Most commonly, perforation occurs as a
result of buildup of pus in the middle
ear due to acute
otitis media
(middle-ear
infection). Perforation may also be asso-
ciated with
cholesteatoma
(accumulation
of skin cells and debris in the ear).
Another cause is injury, for example
from insertion of an object into the ear,
a loud noise,
barotrauma
(damage caused
by pressure changes) or a fracture to the
base of the skull (see
skull, fracture of).
253
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