Otological Symptoms
This content delves into otological symptoms, the diagnostic considerations for hearing loss in different patient populations, and the importance of assessing associated symptoms, time course, and patient age. Common symptoms like otorrhea, vertigo, and tinnitus are discussed, as well as different sources of otorrhea and considerations for evaluating hearing loss in both pediatric and adult patients regarding onset, duration, and associated factors.
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Presentation Transcript
Otological Symptoms Otological Symptoms Prof. Ehab Taha Yaseen FICMS, FRCS Head of Department of Surgery Head of Al-Yarmouk Center for Postgraduate Study Consultant Otolaryngologist
Why this lecture Why this lecture Fact The most informative features in evaluating hearing loss are the: Time course of the loss. Associated symptoms. Age of the patient
Hence, Hence, This lecture reviews: The common symptoms associated with otologic diseases And The diagnoses to be considered when evaluating these symptoms.
Various symptoms can be either suggestive or diagnostic of ear disease. Accurate clinical assessment is facilitated by understanding the significance of symptom combinations and the relative frequency of specific otologic diseases in different patient populations. Common symptoms that indicate an otologic problem are otorrhea, otalgia, aural fullness, hearing loss, vertigo, and tinnitus.
Hearing Loss Hearing Loss A complaint of hearing loss can reflect a wide variety of abnormalities. Diagnostic considerations are different in pediatric and adult patients. Evaluation should determine whether the: Loss is unilateral or bilateral or fluctuating. The time course of the hearing loss. Associated symptoms. Past medical history. Past surgical history. (lumber puncture, era or cardiac surgey) Drug history. FH of HL, neoplasm, renal diseases. Trauma history, including noise and barotrauma.
The most informative features that facilitate determining the etiology of hearing loss are: The time course of the loss Associated symptoms Age of the patient. Onset: acute vs. gradual Duration and pattern long-standing, fluctuating, rapidly progressive, or of unknown duration. Associated symptoms of aural fullness, pain, otorrhea, vertigo, tinnitus, or cranial neuropathies. Side unilateral or bilateral hearing loss is less revealing in determining the etiology of hearing loss.
Otorrhea Otorrhea Is a drainage from the ear. Arise from numerous sources. Have a variety of causes. Sources: 1) External Ear: otitis externa, dermatitis, neoplasm 2) Tympanic membrane: granular myringitis, Bullous myringitis. 3) Middle ear and mastoid: acute OM. Chronic OM, acute mastoiditis, neoplasm and cholesteatoma. 4) Cerebrospinal Fluid: Temporal bone fracture, Tegmen defect, Cochlea deformity
Otalgia Otalgia Otalgia most commonly reflects either localized otologic pathology or a problem within a contiguous, periauricular structure. The physical examination usually reveals the source of the pain. It is common, however, for a patient to complain of ear pain and have no identifiable pathology within the ear. Evaluation of patients with otalgia is facilitated by a thorough understanding of the innervation of the ear. Appreciation of the anatomy underlying shared neural pathways and the potential causes of referred otalgia arising from a distant site enables an astute physician to reach a diagnosis when evaluating a patient with the complaint of ear pain.
Innervation: Innervation: 1. The auriculotemporal branch of the mandibular division of the trigeminal nerve provides sensation to the tragus, anterior pinna, anterior lateral surface of the tympanic membrane, and anterosuperior external auditory canal wall. 2. The vagus nerve provides sensation to the larynx, hypopharynx, trachea, esophagus, and thyroid gland. The auricular branch of the vagus nerve (Arnold's nerve) provides sensation to the concha, inferoposterior external auditory canal, tympanic membrane, and postauricular skin. 3. The glossopharyngeal nerve provides sensory innervation to the oropharynx, tonsils, and tongue base. Jacobson's nerve is the tympanic branch of the glossopharyngeal nerve that provides sensation to the medial surface of the tympanic membrane, mucosa of the middle ear, Eustachian tube, and mastoid air cells.
4. The cervical roots C2 and C3 provide sensation to the postauricular region. 5. The facial nerve innervates the skin of the lateral concha and antihelix, lobule, mastoid, posterior external auditory canal, and posterior portion of the tympanic membrane.
Types of Otalgia Types of Otalgia Primary Otalgia: Arises from local or regional pathology. Sources: acute om, oe, cerumen impaction, inflammation or infection of the auricle, or ear trauma. Regional causes include TMJ dysfunction and periauricular lymphadenopathy from scalp or neck infections. Referred Otalgia: Pain may be referred to the ear from distant sources, such as periodontal or dental disease, parotitis, sinusitis, thyroiditis, tonsillitis, laryngitis, or hiatal hernia with gastroesophageal reflux. In the initial assessment, examination of the ear indicates whether the otalgia is local or regional in origin. If the ear examination is normal, it is helpful to ask the patient to point with one finger to the area of maximal pain.
Aural Fullness Aural Fullness It is subjective symptom. Often described as a stuffy feeling in the ear, ear pressure, or a clogged sensation. If the patient's history reveals associated ear pain, drainage, or hearing loss, the physical examination easily establishes the diagnosis. Causes are variable. Such as: Obstruction of the external ear canal by cerumen, debris, or a foreign body. May result from a soft tissue mass either in the middle ear or arising from the tympanic membrane. Part of Meniere s disease. Perilymphatic fistula. An abnormally patent or an obstructed Eustachian tube. Such patients complain of autophony and of hearing breath sounds in the ear.
Evidence for an abnormally patent eustachian tube includes 1. A history of weight loss, steroid use, or hormonal therapy may precede the onset of symptoms. 2. Relief of symptoms: a) When the patient is supine or bending over b) During periods of nasal congestion. c) With sniffing. Evidence for a chronically obstructed eustachian tube orifice includes: 3. The inability to insufflate the ear with Valsalva s maneuver 4. Chronic retraction of the tympanic membrane. 5. History of nasal congestion and allergic disorder.
Vertigo Vertigo It may reflect disease within the labyrinth, a retrocochlear abnormality involving either the eighth cranial nerve or more central structures, or the effects of a systemic abnormality. A thorough and well-directed history discriminates otologic from non otologic causes of vertigo in most cases. Identification of associated symptoms, the time course of the vertigo or dysequilibrium, precipitating and alleviating factors, and the general medical history should be assessed in patients with vertigo.
The patient's description of symptoms helps in discriminating between central and peripheral causes of vertigo. A sensation of spinning or motion commonly results from acute vestibular dysfunction, such as viral neuronitis, labyrinthitis, and Meniere's disease. Nonvestibular causes of imbalance, such as cardiogenic, metabolic, neurogenic, or psychogenic dysfunction, are often described as a more nonspecific sensation of light-headedness
Tinnitus Tinnitus Common, affecting 30% of people older than age 55 Annual incidence of 5%. Impairs daily life activity affects 3% to 5% of individuals with tinnitus. It results from auditory deprivation from hearing loss induces central neural changes. Mechanisms involves peripheral triggers and central plasticity. Is the perception of sound without an external source Tinnitus can be classified as objective or subjective.
Hyperacusis & Recruitment Hyperacusis & Recruitment Defined as noise intolerance, annoyance caused by ordinary sounds, and abnormal discomfort for suprathreshold sound. These definitions distinguish hyperacusis, considered by many to be a central phenomenon, from recruitment. Recruitment is the rapid growth of perceived loudness with increasing stimulus level and is observed in association with cochlear hearing loss and outer cell dysfunction. Hyperacusis frequently occurs in association with tinnitus but can be present without tinnitus or any associated hearing loss. Hyperacusis can occur after the loss of the stapedial reflex in association with acute facial paralysis.
