Ear Pain Diagnosis
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How Ear pain diagnosis done?
The ear pain diagnosis is usually made with the help of history taking and physical examination. This helps your doctor to find out if the source of pain is within the ear or outside. In this article, you will know about Differential diagnosis for Ear Pain and how ear pain diagnosis done?
After this, your doctor suggests some special examination or imaging tests according to the probable cause of pain.
History taking:
Pain characteristics: Location (pointing finger), pain radiation, aggravating factors (chewing),
Accompanying symptoms: symptoms such as discharge, hearing loss, tinnitus, and vertigo.
Physical examination for Ear Pain Diagnosis:
• Ear examination: your doctor checks your ear (both external and middle ear). He may use devices such as tympanometry or pneumatic otoscope to check for the middle ear or eardrum. For decreased hearing, he might examine with audiometry.
In case of abnormal ear examination, he would suggest more tests according to the probable condition. These can be
• Blood tests: hemogram with DLC, ESR, CRP, etc.
• Imaging tests: CT or MRI for infection in the middle ear, external ear, mastoid, etc.
Once the ear examination is normal, he might check for sources other than the ear
• Nasal examination for rhinitis or sinusitis.
• Oral cavity examination for dental caries, abscesses, tonsils, sore throat, tumor, etc.
• Temporomandibular joint examination for TMJ problem.
• Head examination for parotid gland problem or temporal arteritis.
• Neck examination for enlarged lymph node in neck or thyroid gland problem.
• Cervical spine examination for cervical degenerative changes or muscular pain.
• Cranial nerve examination for cranial nerve neuropathies such as trigeminal, or Ramsay Hunt syndrome.
• Cardiac, respiratory, or abdominal examinations for referred pain from distant organ systems.
Specific Tests for Ear Pain Diagnosis
Following this, the doctor might order some tests according to the probable cause:
• Orthopantogramin case of dental issues.
• CT or MRI foreseeing sinuses, nasal cavities, neck nodes, TMJ, cervical spine, cranial nerves, tumors.
• Endoscopy for tumors of throat, larynx, etc.
• Blood tests such as complete blood count (CBC), etc.
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How to identify the cause of ear pain, and what are the tests done?
Common causes – the source of pain in the ear to know before the Ear Pain Diagnosis
| Cause of earache | Identifying | Features Tests |
|---|---|---|
| Otitis Media-an infection in the middle ear | • Severe pain, often with cold symptoms • Sometimes ear discharge with the rupture of the eardrum • Recent history of respiratory infection • More common among children | Examination of the ear- examining ear using a pneumatic otoscope. • Findings-Bulging, opacification, immobility, and redness of the eardrum. • Sometimes shows perforation in the eardrum. • Audiometry done in case of decreased hearing. |
| Otitis externa- infection in the ear canal | • Itching and pain (increased itching and minor discomfort in chronic otitis externa) • History of swimming or constant exposure to water. • White, foul-smelling ear discharge | Ear examination- Red, swollen external ear canal that is filled with pus-like material Pain aggravated by compression or pulling of the ear. CT scan- to know the exact extent of the condition |
| Barotrauma– changes in pressure | • Pain, decreased hearing, or buzzing sensation associated with change in height- airplane or sea diving. | Examination of the ear- • Shows ear drum bleed. • Fluid in the middle ear. |
| Impacted wax or foreign object | • Wax or a foreign object such as insect • Common in children | Ear examination- shows impacted wax, foreign body in the ear canal. |
| Acute eustachian tube obstruction – caused due to cold or allergies | • Nasal congestion or sore throat • Gurgling, crackling, or popping noises in-ear with mild to moderate discomfort or pain • Decreased hearing in the affected ear | Examination of the ear- examining ear using a pneumatic otoscope. Examination of the throat- shows swelling or occlusion of the eustachian tube opening in the throat. |
Less common causes- the source of pain in the ear
| Cause of earache | Identifying Features | Diagnosis |
|---|---|---|
| Injury | • Most commonly happens while cleaning the ear • Discharge in case of rupture of eardrum | Ear examination- shows injury to external canal or eardrum |
| Mastoiditis | • Recent middle ear infection • Redness, swelling or tenderness behind the ear • Sometimes with fever and/or ear discharge | Examination of the mastoid area- painful on touch or swelling in the mastoid area. CT Scan or MRI- shows fluid in the mastoid. |
| Infectious myringitis-eardrum infection | • Severe pain in the ear • History or symptoms of cold or respiratory infection
| Examination of ear- • Swollen eardrum. • Small blisters on the surface of the eardrum. • Fluid in the middle ear. |
Common causes of ear pain with source outside ear
| Cause of earache | Identifying Features | Diagnosis |
|---|---|---|
| Dental issues- carries or abscess | • Pain in tooth • Swelling in the gum | Oral examination- pain on touch or carries or swelling Dental imaging- OPG scan |
| Cancer of the throat, tongue, voice box, upper throat, nasal passages, tonsils | • Chronic discomfort • Often a long history of tobacco and/or alcohol use • Sometimes enlarged, non-tender lymph nodes in the neck • Usually in older people | • MRI or CT scan • Endoscopy with removal and examination (biopsy) of visible lesions |
| Pharyngitis or Tonsillitis | • Pain while swallowing • Sore throat • Visible redness in the throat | Oral examination– shows swollen and red throat or tonsils Culture– done to identify the microbe |
Uncommon causes of ear pain- source outside the ear
| Cause of earache | Identifying Features | Diagnosis |
|---|---|---|
| Neuralgia – inflammation of the nerves (such as trigeminal neuralgia) | • Intense, sudden, electric shock-like pain, usually that last less than 1 second | Examination- may have trigger points MRI- may show compression on trigeminal nerve |
| TMJ disorders– a disorder in the hinge that connects your jawbone to your skull | • Pain increases when the jaw moves or with biting • Cracking sound while eating | Examination- pain on touch just in front of the ear or muscles of the jaw. MRI/CT- generally not required. |
| Bell’s palsy- swelling of nerve that supplies to the muscles of the face | • Paralysis of face on one side- seen as deviation of face to the other side. • Pain occurs behind the ear on the same side as paralysis- may occur before or after the onset of paralysis. • Seen in 25%-50% of the patients • May have a history of exposure to cold. | Examination- Paralysis involves the entire one side of the face, including the forehead. CT or MRI- Diagnosis made by exclusion of other causes of paralysis such as brain tumor- is done. |
| Temporal arteritis– swelling of the temporal artery, seen in less than 1 % | • Usually above 50 years of age • Double vision • Jaw tiredness on chewing firm food- meat or prolonged speaking | Examination- arteries are beaded and tender. ESR-more than 50 USG doppler Biopsy- a small sample of tissue taken |
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