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Ear pain (otalgia) is a common reason for visits to family physician offices and emergency departments. Otalgia is primary when the pathology originates from the ear, and is secondary for disease processes associated with otalgia and an ear examination with normal findings. The most common diagnosis related to otalgia in children and adults is acute otitis media (AOM). It is characterized by an erythematous, bulging, and cloudy tympanic membrane. Otitis media with effusion is the presence of fluid behind the tympanic membrane without signs of inflammation. Chronic middle ear effusion is managed definitively with myringotomy and tympanostomy tube placement. Tympanic membrane rupture is a common complication after AOM or trauma. Tympanic membranes that do not heal develop chronic infection, leading to chronic suppurative otitis media. Initial management is cleaning and drying of the ear and application of topical antibiotics. Otitis externa is a painful cellulitis of the external auditory canal associated with erythema, edema, and occasional drainage. Cerumen impaction is managed with cerumenolytics, irrigation, or manual extraction. Foreign bodies in the ear are common in children younger than 6 years. Many foreign bodies can be removed with irrigation or forceps.

Case 4. Scott is a 13-month-old boy who is brought to your office by his parents for fever and irritability. He has been grabbing at the right ear for the past 3 days. He has had three previous ear infections at ages 6, 9, and 12 months; each infection was managed with antibiotics. He is otherwise healthy and has received all recommended vaccinations.

His parents say that since he has started attending day care about 6 months ago, he has had frequent colds. Scott has no siblings. He is exposed to secondhand smoke in the home.

Epidemiology

Ear pain (otalgia) has many etiologies and is a common reason for visits to family physician offices and emergency departments (EDs). In EDs, 1% of adult visits and 6.8% of child visits are for ear pain.91 Common associated symptoms include hearing loss, otorrhea, tinnitus, or vertigo.

Otalgia is classified as primary when the pathology originates from the ear, and as secondary for disease processes associated with otalgia and an ear examination with normal findings.92 Primary otalgia is more common in children than in adults, with acute otitis media (AOM) being the most common diagnosis.91,92 Adults are more likely to have secondary otalgia. Primary neoplasms of the ear and temporal bone are a rare cause of otalgia.

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