Ahmed, a 13-year-old presented to the clinic with

Earache
1. Causes
  1. Otitis Media
    1. Infection of Middle Ear
      1. Signs and Symptoms
        Earache, ear pulling, purulent discharge, diminished hearing, tinnitis
      2. Causative Microorganisms
        Bacteria
        S. pneumoniae H. influenzae Moraxella catarrhalis
        Viruses
        RSV Rhinoviruses Influenza viruses Adenovirus
    2. No tenderness Normal EAC, Edematous and bulging tympanic membraen
  2. Otitis Externa
    1. Infection of External Ear
      1. Causative Microrganisms
        Pseudomonas aeruginosa S. aureus Proteus mirabilis
    2. Tenderness EAC swollen Normal Tympanic membrane
  3. Eustachian tube dysfunction
  4. Referred Pain
    1. TMJ Syndrome
      1. Ear Pain
      2. Jaw Pain
      3. Neck Pain
      4. Headache
    2. Dental Infection
    3. Pharyngitis Tonsillitis
    4. Sinusitis/Rhinitis
    5. Trigeminal Neuralgia
    6. Esophagitis
  5. Foreign body in the ear
  6. Trauma
    1. Laceration
    2. Abrasion
    3. Barotrauma
      1. Deep Sea Diving
  7. Mastoiditis
  8. Mumps
  9. Psoriasis
2. Definition
  1. Pain in the ear
    1. Anatomy of the ear
      Attachments:
      - Anatomy of the Ear
      1. Inner Ear
        Sensory Organ: Cochlea
        Scala vestibuli
        Contains Perilymph
        Helicotrema
        Point of Communication
        Scala media
        Contains Endolymph
        Scala tymoani
      2. Middle Ear
        Auditory ossicles
        Malleus
        Incus
        Stapes
      3. External Ear
        Collects sound waves and channels them down the auditory channel
      4. Seperated by: Tympanic Membrane
        Pearly grey, translucent, with a sharp light reflex and bony landmarks
Ear Discharge
1. Types
  1. Wax
  2. Pus
  3. Mucus and/or Muco-pus
  4. Blood
    1. Fresh blood
    2. Tinged
  5. CSF
2. Causes
  1. Cancer of Ear Canal
  2. Chronic Purulent Otitis Media
  3. Trauma
  4. Otitis externa Swimmers Ear
Vertigo
1. Spinning sensation while body is stationary with respect to surroundings
  1. In a healthy person, stability is mainted by the vestibular apparatus
    2. Otolith organs
      1. Saccule
        Macula is vertical
        Up and Down
      2. Utricle
        Macula is horizontal
        Right and left
      4. Macula
        sensory organ
        Covered in a gelatinous layer
        Hair
        statoconia
        CaCO3 Stones
    3. Semicircular canals
Tinnitis
1. Types
  1. Subjective
    1. Only patient can hear it, most common type
  2. Objective
    1. When both patient and doctor can hear it, more rare
2. Ringing, buzzing, roaring or clicking
  1. Sounds one normally does not hear
    1. Physiology of normal hearing
      2. ss
3. Causes
  1. Age-related hearing loss
  2. Exposure to loud noise
  3. Earwax blockage
  4. Changes in ear bones
  5. Acoustic neuroma
  6. Blood related causes
    1. Atherosclerosis
    2. High blood pressure
    3. Arteriovenous malformation
  7. Medications
    1. Chloroquine Aspirin Diuretics
Aural Polyp
1. Pedunculated granulation tissue Mass
2. Causes
  1. Infection
  2. Cholestatoma
    1. Cystic loculation of squamous epiithelium in the middle ear or mastoid process which enlarged by erosion of underlying bone
      1. Types
        Congenital
        This type of cholesteatoma is very rare, and occurs when squamous epithelium residue remains in the middle ear during development of the embryo.
        Acquired
        Primary
        Retraction Pocket
        Basal Cell Hyperplasia
        Squamous Metaplasia
        Secondary
        Epithelial migration
        Teriairy
        Post-traumatic
        Post-tympanoplasty

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Ahmed, a 13-year-old presented to the clinic with

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