Ear pain may occur with hearing loss alone or together with discharge or, rarely. Pathophysiology pain may originate or from a process within the ear itself be projected from a nearby nichtotologischen disturbance on the ear. Pain in the ear itself may be due to a pressure differential between the middle ear and the outside air and / or local inflammation. A pressure drop in the middle ear usually has prevented a balance between the pressure in the middle ear and the atmospheric pressure and at the same time an accumulation of fluid in the middle ear which enables installation of the Eustachian tube the result. In an otitis media eardrum inflammation and pressure increase lead in the middle ear pain and bulging of the eardrum. Referred pain can be due to disturbances in the Innervationsgebieten the cranial nerves V, IX and X, which supply the outer and middle ear sensitive. Specific innervation are nose, paranasal sinuses, nasopharynx, teeth, gums, TMJ (Art. Temporomandibularis), mandible, parotid glands, tongue, tonsils, pharynx, larynx, trachea and esophagus. Disturbances in these areas sometimes embarrassed the Eustachian tube (Eustachian tube), resulting in pain due to the pressure gradient in the middle ear. Etiology ear pain can have otological (with participation of the outer and middle ear) or nichtotologische causes, if disease processes near projected on the ear (see Table: Causes of ear pain). The most common causes of acute pain are: otitis media infection of the outer ear are the most common causes of chronic pain (> 2-3 weeks): dysfunction of the temporomandibular joint (Art temporomandibularis.) Chronic dysfunction of the Eustachian tube chronic otitis externa In chronic pain must also always a tumor will be considered, especially in elderly patients and if the pain is associated with discharge from the ear. In people with diabetes or other conditions immunkompromittierenden a particularly severe form of otitis externa may develop, which is referred to as malignant or necrotizing otitis externa. When striking soft tissue is found in the examination of the ear canal, a biopsy must be performed to rule out cancer. A malfunction of the temporomandibular joint is a common cause of ear pain in patients with no abnormal findings in the investigation of the ear. Causes of ear pain cause suspicious findings * Diagnostic procedure middle ear acute obstruction of the Eustachian tube (Eustachian tube) Less severe discomfort gurgling, crackling or popping sounds, with or without nasal congestion eardrum not red, but decreased mobility unilateral conductive hearing loss Clinical evaluation barotrauma Significant pain sudden air pressure Change augmentation in the history (eg. As air travel, diving) Frequently circulation on or Clinical behind the eardrum clarification mastoiditis short past otitis media may otorrhoea, redness and tenderness over the mastoid Clinical evaluation Usually, CT to monitor the scope and sometimes MRI if intracranial complications are suspected otitis media (acute or chronic) Significant pain, often symptoms of infections of the upper respiratory tract Plump, reddened eardrum More common in children may discharge in perforation of the eardrum Clinical evaluation External ear Zeruminalpfropf or debris visible Local at Otoscopy Clinical evaluation trauma Usually attempts the ear to clean lesion of the auditory canal at Otoscopy visible Clinical evaluation otitis externa (acute or chronic) itching and pain (more itching and only mild discomfort in chronic otitis externa geröte) Frequently after swimming or after repeating the action of water Sometimes malodorous discharge meatus t, swollen; purulent detritus eardrum normal Clinical evaluation CT of the temporal bone in suspected malignant otitis externa Nichtotologische causes tumor (nasopharynx, tonsils, base of the tongue, larynx) Chronic pain often tobacco or alcohol consumption Sometimes middle ear, cervical lymphadenopathy Usually the elderly gadolinium MRI biopsy of visible lesions infection (tonsils, peritonsillar abscess) pain on swallowing visible Rachenerythem protrusion at abscess Clinical evaluation Occasionally streptococci culture neuralgia (N. trigeminal, glossopharyngeal, sphenopalatine ganglion, geniculate ganglion) Arbitrary, a short, severe, sharp pain Clinical evaluation TMJ disorders pain aggravated by jaw movement, * is missing mobility of the temporomandibular joint Clinical evaluation A degree of conductive hearing loss in many diseases of the central and outer ear common. Frequent feature is an ear examination with negative results. TM = eardrum; TMJ = Temporomandibular Joint. Clarification history The history of the disease process should assess location, duration and severity of the pain and whether it is constant or intermittent pain. If there are intermittent pain, it is important to determine whether these occur randomly or mainly in swallowing or moving the jaw. Important associated symptoms include ear discharge, hearing loss, and sore throat. The patient should be previous history of any attempts to clean the ear canal (z. B. with cotton swabs) or recently instrumental interventions, foreign bodies, recent air travel or scuba diving and swimming or other repeated contact of the ears are interviewed with water. In reviewing the organ systems should be asked about symptoms of a chronic disease such as weight loss and fever. The history should by a known diabetes or other conditions immunkompromittierenden, earlier diseases of the ears (especially infections) and on the extent and duration of tobacco and alcohol consumption fragen.Körperliche investigation In the investigation of vital signs to watch out for fever. The physical examination focuses on ears, nose and throat. The pinna and the region over the mastoid should be inspected for redness and swelling. The auricle is pulled gently; a significant increase in pain when you drag points to otitis externa. The ear canal should be examined for redness, discharge, swelling, cerumen or foreign objects and other lesions. The eardrum should be examined for redness, perforation, and signs of fluid accumulation in the middle ear (z. B. bulge, deformation, variation of the normal light reflex). A short Hörtestsollte be performed at the bedside. The neck should be on redness, exudate tonsilläres peritonsillar swelling and mucosal lesions that indicate a tumor studied. The function of the temporomandibular joint should be assessed by palpation of the joints during opening and closing of the mouth; also should be paid to trismus or evidence of bruxism. The neck should be sampled after a lymphadenopathy. A fiberoptic examination of the throat and larynx in practice should be considered, particularly when no cause for the pain can be identified in the routine testing and if nichtotologische symptoms such as hoarseness, difficulty swallowing or nasal obstruction reported werden.Warnzeichen are the following findings of particular importance: diabetes or immune-compromised state redness and fluctuation over the mastoid and prolapse of the pinna Marked swelling on the outer ear canal Chronic pain, especially when associated with other head / neck symptoms interpretation of the findings is a key differentiator, whether the examination of the ear fails normal; Diseases of the central and outer ear cause abnormal physical findings that indicate an etiology with a history in general (see table: causes of ear pain). For example, patients with chronic dysfunction of the Eustachian tube abnormalities of the eardrum, typically a retraction pocket. Patients with an inconspicuous ears investigation have a visible oropharyngeal cause such. B. a tonsillitis or peritonsillar abscess. Ear pain due to neuralgia associated with classical symptoms such as short (usually seconds, always <2 min) Episodes extremely severe, stabbing pain. Chronic ear pain without abnormalities in the ears study could be due to a disorder of the temporomandibular joint; in these patients a thorough investigation of the head and neck (including fiberoptic examination) should be made to a cancer auszuschließen.Tests are Most cases by history and physical examination obvious. Based on clinical judgment nichtotologische causes, further tests require (see table: causes of ear pain). In patients with an inconspicuous ears investigation, in particular in those with chronic or recurrent pain, an evaluation can be justified by an MRI, in order to exclude a cancer. Therapy underlying disorders are treated causally. The pain was treated with oral analgesics; usually an NSAID or paracetamol is adequate, but sometimes it requires a short administration of an oral opioid, especially in cases of severe otitis externa. In cases of severe otitis externa an effective treatment requires the extraction of debris from the ear canal and the insertion of a cotton / gauze strip, which allows the delivery of antibiotic ear drops on the infected tissue. Topical analgesics (eg. As antipyrine benzocaine combinations) are not very effective in general, but can be applied to a limited extent. Patients should be instructed not objects (no matter how soft the objects are or how careful the patient claims to be) into their ears. Patients also should perform ear flushing until medical supervision and very carefully yourself. For ear rinses an oral irrigator must not be used. Summary Most cases are due to infection of the middle or the external ear. History and physical examination are sufficient for diagnosis in general. Nichtotologische causes should be considered when studying the ears is normal.