* Deatiness F Pain or orate Referred F ed otagia rorthea or discharge Common sym the patient comes Deatiness. nptoms of ear Pain or otalgia 1 3. Owrte: nea or discharge 4. Tinnitus. é 5. Vertigo. 6 Itching or iriation 7. Swelling or deformity. 8. Facial palsy/asymmetry 9. Hyperacusis and autophony. 10, Trauma or Forcign body. 11. Bleeding. ( 12, Other symptoms like fever, nausea, vomiting and neurological symptoms Tinnitus ie a Fa pyymeny ching or irritation. a Svellng or cay as * the ise DEAFNESS ‘Deafuess or hearing impairment sa common sympiom children. Deafness m: ‘escape notice of the patient to complete loss of heart ‘or complete. According t0 the jon of deafness is So, the deafiess may be part follows: Normal fi Mild deafiness ‘Moderate deaf + Moderately severe deafness Severe deafness one deafness ring, vary from a de Severity, most commonly used classifica ion peopl up t025 4B. 26-4068 41-55 dB 56-70 dB 71-91 dB >o1dB es because of which of ear disease. It is the decrease in the ability to hear According to WHO report, 360 1 hhave disabling hearing loss and among these worldwide million are 7 0 slight as to Following ae d : So he nines psf dest 2. Sensorineura 3. Mixed. 4. Non-organic. Conductive Deainess: Tn conductive deafness conductiv then prthway of the sound to pathology may lie in the external ea is patho he inner ex. The ile ea ill the ly, in conductive de yut nor distorted foot plate ofthe stapes. Typ sound appears g he quality because the patient hears his of speech is well mai ‘own voice clearly: In so ductive deafness This ta phenomenon where the patent heater ¢he nary environment than the quiet and souls one The common causes of conductive deafness ince: Impacted wax in the external auditory nal 2. Big foreign body in dhe external auditory canal 3. Ovomycosis 4, Boil iflarge enough. 5, Tumors: eg osteoma 6. Congenital atresia and malformations 7. Acute and chronic otis media 8, Otitis mela with effsion 6, Trauma: ear drum petfration oF dislocation of the ossile 10, Otosclerosis and tympanoscleross 11, Busachian be dysfunction du to pathologies of the ike enlarged adenoids and tumors ofthe nasopharynx nasopharynx. 12, Iatrogenic: eg, surgical.Senserineural Deatness crincural deafness, sotind not only appears sorted as well The most usual distortion sound, which diminishes the understanding of consonant sounds resulting in diticule specch. Dis pronounced in neural ype of in understanding sfness than the sensory type ‘Of deafness In severe eases the patient may not hen dee ‘own voice, so the speech is also loud and expressionless The common causes of sensorincural eafnee ore Genetic: In gen inherited fy ie causes, defective genes are nthe parcras The b._Non-genetic: genes are not defective and include i. Prenatal causes: during pregnancy, conditions like rubella, use of ototoxic drugs, radiation, viral infections et Hi, Peri-natl causes: eg, birth hypoxia, prematu- rity low birth weight iii, Postnatal causes: Rh factor incompatibility and hypothyroidism. 2 Labyrinthitis, 3. Perilymph or endolymph leakage 4. Trauma to inner ear or cochlear nerve bustic trauma and blast injuries 6. Noise Induced Hearing Loss (NIHL), 7. Meniere's disease 8 Acoustic neuroma Presbycusis, CVA, space occupying lesions Systemic diseascs: e.g. diabetes mellitus, hypothyroid ism, aitoimmune disorders, multiple sclerosis, Mixed fause both and mixed deafness, like otosclerosis deafiess by fixation of footplate fer stages may lead to sensorineural Amalogous way, the cholesteatoma initially conductive deafness, aso called hearing. Thi ype includes mulingering or o* med purpose, psy Prychological illness wh deualed history, thorough. clinial cams? gical investigations. History about a rust incl + Durston of hearing loss, Continuous, intermittent or fucuan; + Unilateral or bilateral, + Difficulty in understanding * Associated symptoms. Acgravating and relieving factors, + Occupational history *+ Exposure to loud sounds. * Use of ototoxic dr fauma to head or ear mation includes complete & ‘of the ear with voice test and cutting 4). Audi chaps ork tas ae investigations are described death ___PAIN OR OTALGIA ialgia may occur either di complications in the ear or complicat rewhere de having the same sensory nerve supply as the car (rfl somplications in the ear may ether be inthe pain fiber Malia). Th al ear or the middle ear, Inner ear has so diseases of the inner ear are mostly painless. are mostly pain The common complications in the external ear are Acute diffuse otitis externa, Boils 3. Oromycosis, 4. Bullous myringits 5. Herpes zoster oticus 6. Perichondrits, 7. Tra 8. Im ima or foreign body 9. Malignant otitis externa, 10. Neoplasia third one-hid is tke d supp An cer wih other 1 2 a 4ol Deatness ‘caunes conduction deafness but ter ay erode the iy Stra cause sensorineural deafness as wel me sled une Meee ieee Uacnatiacy, coset real conu cane fon audiological investigations. History corted as well, The fequency sound. which diminishes the ot the deafney must include consonant sounds resulting in difficulty + Duration of bearing loss. speech, Distortion of sound is more 6 Onset ra typeof deafnewthanthesemsoryeype ee ere cases the patient may not hear their ae speech is also loud and expressionless, pe es of sensorineural deafiess are + Continuous, intermittent or Bactuant, ses: + Unilateral or bilateral. spots ext, defers gepeg ere) Hea better in naizy room arin a quics oom, ban the parents + Difficulty in understanding speech The genes are not defective and © Associated symptoms. + Aggravating and relieving factors, causes: during pregnancy, conditions + Occupational h Occupational history Ba use of ototoxic drugs, radiation, x yrare ws load rads + Use of ototoxic drugs birth hypoxia, promata- Trauma to head or ea Clinical examination includes complete examination of the 4). Audiological investigations are described in detail im Bicxor incompatibility ‘ea with voice test and tuning fork t PAIN OR OTALGIA Pain in the ear or otlgia may occur cither duc vo complications in the ear or complications somewhere else haying the same sensory nerve supply as the car (tered (tapi). The complications in the ear may either be in the EMerhal car or the middle car. Inner ear has no pain fibers, Bodiscascs of the inner car are mostly painless. he common complications in the external ear are: L._ Acute diffuse otitis externa 2. Boils. 3. Otomycosis. 4, Bullous myringitis. 5. Herpes zoster oticus 6. Perichondritis, luctive and 7 Trauma oF foreign body ike otosclerosis rien 8. Impacted wax tion of footplate to sensorineural yolesteatoma initially 9, Malignant otitis externa 10, Neoplasia. erve supply of dh plows C2 mcg ea 2) dl he medal sare third i sup one-third bythe by the reer sah ines lower one-third w aed Th perl rly w the anetor blot te een m the auricle semper ney nch oth ben gus nerve Supping he nerve supply of the ous is like that of dhe canal. Ame suriculoten the tr chi sed a nerve (ranch of mandir de el an poe bl bythe snc is supplied bythe ympnichrnchet he gn Any painful pathology in the distribution of nerves may cause refered pin in the ea. Digna referred ota ismadeby xn lena with no postive finding in the ear and presence of other pathology in the head and nek region, Some of the common causes of refered olga Post tonsillectomy operation. ost adenoidectomy operation 3, Dental diseases or tooth exracion. 4. Carcinoma of pytiform fas base of tone sil 5. Nasal and PNS diseases 6. Acute tonsils 7. Peritonsllarabsces. 8 Uleers in the mouth and pharys. 9, Cervical spondylosis or aris (C2 and C 10, Salivary hand seas 11, Temporomandibuar int dysfunction. eemination ae chay apr per letail in of is supplied by the tympanic br Any painful pathology’ in the Peferred oxalvia isn ith: no positive findin BBther pathology in the hea kre Post adenoidectomy oper Dental diseases or tooth extraction pyriform fossa, base of tong a 1 4, Carcinoma of sil Nasal and PNS diseases Acute tonsils PeritonsilligaBBeess Ulcers in the mouth and pharyns. (2 and C3 nerves) 6. Cervical spondylosis or arthritis 8. Waxafeer softening History of dischargs* Blood stained or + Aggravating and relieving factors + Associated symptoms, m Tinnitus isthe subjective sensati “Tine efeitos Latin ond the individual perceives the sound in the absence Sf ex al 1nd and perception is unrelated to any external source cf at dave i esa glee EMSRS at dnd verylinied therapy i aalable to climate the ae sound varies hissin Two clinical forms of tinnitus are recognized: 1 Tinnieus with dea Tinnitus without deafness Tinnitus with Deafness This form of tinnitus is more co! due to diseases within the ear. In fact, ‘can cause tinnitus, Some of the comm mon and is usually type of deafness nn causes of dinnitus swith deafness are: 1 Presbycusis ‘Meniere's disease Ototoxicity 4. Acoustic trauma or blast injury 5, Noise induced hearing loss. 6 Acoustic neuroma 7. Labyrinthitis 8. Otitis media. 9. Eustachian tube dysfunction. 10. Impacted wax or entry of a foreign body like insect. 11, Glomus tumors. Tinnitus without deafness: innitus may occur without deafness In few patients, In majority of these cases, cause is unknown. Some of the common causes of tinnitus without deafness are: 1. Idiopathic: most common. Hypertension or hypotension. Anemia. Hypoglycemia. Vascular: vascular malformation, arterio-vet {h, atherosclerosis, venous hum, jugular bulb etc. a 3, 4. 5, nous fistu- jomaly 6. Migraine 7. Epilepsy 8, Contraction of intratympanic o pala ‘Another classifi te of the tng also commonly use "iM 1. Objective tnnius: It Snius whi everyone as well a8 the pation, Ona is relatively rare. It is sound ercaicy the bods, usually in the « = ‘muscular or vascular etiology, being is head 2, Subjective tinnitus: When the tinnita ‘operant to the patient. This is the more commen lap Detailed history is ve at v 4 nporan ot ae ‘ae eae Ab floc! heag, Roepe © Duration ta = + Omer woul! ‘+ Progression. — + Unie or ilar > Charcer and mature o€ he nile or hissing ct, Pulsatile cnnits ius fe + Aggavaingand rclierng Bem Ors sociated mpeoms VERTIGO See chapter 13. ITCHING OR IRRITATION Tiching or irtation in the earls generally ss with some form of otitis externa. It may ¥ary in som and can be so severe that the patient may even sbi ‘meatal skin by himself through rubbing oF scratching’ external auditory canal with a sharp or pointed obit keys, hair pins etc. Sometimes itching may resltiont accumulated wax. Otomycosis is another imparast as of itching in the ear. SWELLING OR DEFORMITY “Siwelling of the pinna may occlidue t perches of the pinna. Postauricular swelling is ‘commonly 4" ‘ess. Swelling inv the preauricular 1 lar sins are ba a mastoid absc ‘may occur due to an infected preauric Causes of swelling in the external auditory canal or osteoma of the canal. Deformity of the pinna is usually due t 2 cong anomaly. Trauma is another cause for deformity © boxer's ear. pinn: FACIAL PALSY /ASYMMETRY _~ See chapter 15.not 6. Migraine relieving fictors Epileps §. Contraction of intratympanic or palatal muscles Another classification of the tinnitus i310 660 types, _ TINNITUS. jective sensation of sound 0 LessObjective tinnitus: It is innitus which is audible 4 patient. Objective sinning, Bisons as well as ch Bh eluively rare, It is sound created somewhere in the boxy, usually in the ear, head or neck, and has crm cio in dece g ich means “0 ring” Typical fe sound in the absence exer is unrclaed to ny sl SOE and somtimes dhe only symaptons 2 Subjective in cred a+ 3 sigil imtadon oF the woe pavicnt, This isthe more hays Nature she sound ¥aieS Detaled history is very importa zane hissing hamMETINE dhe Ginnies and must nclode to find the cause of SERRE 2 “Dur sir: eh amiable sme ctenimates te, nine Norns o K f tinnitus are recognized: Progression, eral or bilateral # Associated with deafness or not © Character and nature of the tinnitus: like pulsatile fr hissing etc, Pulsatile tinnitus is usually of vascular origin. @ Aggravating and relieving factors. Others associated symptoms VERTIGO Sce chapter 13. ITCHING OR IRRITATION. nerally asso ated Thing or irritation in the ear orm of otitis externa, It may vary in severity and can be so severe that the patient may even abrade the meatal skin by himself through rubbing or scratching the external auditory canal with a sharp o pointed object like keys, hair pins etc. Sometimes itching may result from the accumulated wax. Otomycoss is another important cause with some of itching in the ear SWELLING OR DEFORMITY Swelling of the pinna may occur due to perichondritis of the pina, Postauricular swelling is commonly due t 4 mastoid abscess. Swelling in the preauricular region tay occur due to an infected preauricular sinus or cyst Causes of swelling in the external auditory canal are boils or osteoma of the canal. + Deformity of the pinna is usually due to a congenital anomaly. Trauma is another cause for deformity of the pinna eg. boxer’s car. By occur without deafitess. ‘is unknown. Some of the hout deafness are: tion, arterio-venous fistu- um, jugular bulb anomaly FACIAL PALSY /ASYMMETRY_ ______ FACIAL PALSY/ASYMMETRY See chapter 15, ae ‘migraine, depression, - re pean ceo with abnormally pee = aes cea a Boke enema Present in pie The ether ca Y el by the wae ct rach we As the ear +s concerned wth hearing nd a oe ‘elated with hearing while w es asifed into two main pes, eal 10 types. Tinnitus mayb sated a cause maybe preset inthe uta er ua ral cra ail: Apa un fe from ether exernal ar or mike Macs from the middle e: = a RRPui Fasc, Hyperacusis is cy i ee Mncreased Sensitivity to so. Phonophobis in severe cases T seo Ws unknown but ic is rf TRAUMA OR FOREIGN sooY The patient may erent degpes of es for this the boy could be aime wr aes eXposieshead injary Memes ine ke cockroach amor moauieo may ene Wy ey while inanimate foreign bodies ate inueiaeed er Pereeption of 3 person's own voigeidad errata his own breathing sounds. It is typi select blocked external aitory canal By the wae va hearing aid. — ‘common but isan important and tenifjing symptons Ye in monty seen ace trata tothe ear of surrounding region. Vascular tumors lke hemangioma of the external car or glomus jugulare are other important causes of bleeding rom the ear ecu hms | classified into two main types, conductive and sensorineural deafness. Mixed and non-organic deatiness are the other ternal ear are painless. A good number of cases of earache are duc to referred otalgia. Disch Ifrom cither external ear or middle ear. Mucous glands are absent in external car, so mucoid discharge alway from the middle ear symptom, where the | mn, Diseases of the