1 / 27

52 y/o female with ear pain

52 y/o female with ear pain. [O] [P] [Q] [R] [S] [T] [A]. Onset one week prior Worsened with chewing Throbbing Left ear Almost disabling Intensifies over 3-4 minutes Associated jaw “clicking” and “popping” Also with nasal congestion, headache. Pertinent negatives.

HarrisCezar
Download Presentation

52 y/o female with ear pain

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 52 y/o female with ear pain [O] [P] [Q] [R] [S] [T] [A] • Onset one week prior • Worsened with chewing • Throbbing • Left ear • Almost disabling • Intensifies over 3-4 minutes • Associated jaw “clicking” and “popping” • Also with nasal congestion, headache

  2. Pertinent negatives • No vision change or eye pain • No tooth or throat pain • No jaw claudication • No fever or chills • No otorrhea

  3. PMHx: HTN Hyperlipidemia H.pylori ?Pre-diabetes All: PCN - rash Meds: Zestoretic Atorvastatin Omeprazole Clarithromycin Metronidazole History

  4. Exam • BP 125/74 Wt 88 kg • Gen: NAD • HEENT: • PERRL, EOMI, anicteric, non-injected • TMs translucent, no pre-/post-auricular tenderness • Clear-white rhinorrhea with minimal turbinate erythema, no sinus tenderness • Subluxation/crepitus of left jaw • Neck: supple, no LAD/masses, no bruits

  5. Otalgia Thank you, eMedicine.

  6. Agenda • What is otalgia? • What is TMJ? • Where can I eat for free today?

  7. Otalgia: the pathogenesis • Sensory nerves of the ear • CN V - auriculotemporal branch • CN VII - Ramsey-Hunt branch • CN IX - Jacobson branch • CN X - Arnold branch • C1, C2 • Neuroanatomic otalgia • Spinal tract nucleus of CN V • CN V, VII, IX, X, C1, C2, C3

  8. Trigeminal nerve

  9. Facial nerve (VII)

  10. Glossopharyngeal and Vagus

  11. Primary Otitis media Otitis externa Mastoiditis TM perforation Foreign body Referred Dental TMJ Dental abscess Poorly-fitting denture Oral cavity Tongue Sinuses Throat Tonsillitis/pharyngitis Eustachian dysfunction Neck Musculoskeletal Other Neuralgias Tumors Angina Temporal arteritis Zoster Otalgia: the differential

  12. Otalgia: the H&P • History • Otologic symptomatology • Dental problems • Sinus problems • Swallowing disorders • Cervicofacial pain syndromes • Recent trauma • Cardiopulmonary history • Physical

  13. Otalgia: the exam Ear normal? No Yes Thorough head and neck exam Done

  14. Temporomandibular Joint Syndrome

  15. TMJ: Names • Costen disease • TMJ • TMJ syndrome • TMJ disease • TMD • TMJD

  16. TMJ: Causes • Myogenous • Bruxism • Daytime jaw clenching • Arthrogenous • Disk displacement disorder • DJD • Systemic arthritic conditions • Ankylosis • Infections • Neoplasia

  17. TMJ: Demographics • Male:female - 1 : 4 • Caucasian > African-American • Age - 20-40 years • Lifetime prevalance - 5-10%

  18. TMJ: History • Pain • Sounds • Jaw opening/locking • Headaches • Other

  19. TMJ: Exam • Asymmetry • Malocclusion • Jaw opening (between incisors): 5 cm • Protrusive/lateral jaw movement: 1 cm • Muscle spasm • Joint sounds

  20. TMJ: Associations • TNF-alpha • IL-1ra • sIL-1rII • COMT

  21. TMJ: Imaging • Panorex

  22. TMJ: Treatment • Meds • NSAIDs • Opiates • Muscle relaxants • Tricyclic antidepressants • Occlusal splints • Physical therapy • Surgery

  23. Back to our patient…

  24. Plan • Cyclobenzaprine 5mg TID PRN • Jaw exercises • Dental follow up, if needed

  25. Recap • All ears that ache aren’t earaches • Normal ear = more exam • Treat the cause of TMJ, although most cases resolve spontaneously

  26. The End?

More Related