Ear Pain
Ear pain (otalgia) is primarily caused by ear disorders, though a small proportion is classified as referred pain. The nature of the pain can vary and include dull pain, stabbing pain, or throbbing pain.
Inflammatory Pain
Inflammation, often caused by bacterial or viral infections, can result in acute or subacute pain. Due to the limited loose subcutaneous tissue in the auricle, inflammation of the auricular cartilage can cause high local pressure, leading to intense pain. Chronic inflammation of the external auditory canal typically presents as dull pain, while furuncles in the external auditory canal cause severe pain. Necrotizing external otitis manifests as dull pain with external auditory canal bleeding. Middle ear inflammation usually results in dull pain; however, infants and young children may experience severe ear pain, often accompanied by crying, head-turning, and ear scratching.
Traumatic Pain
Blunt force trauma, sharp object injuries, firearm injuries, burns, frostbite, barotrauma, blast injuries, and shock wave-related damage to the ear are common causes of ear pain.
Tumor-Related Pain
Conditions such as middle ear carcinoma typically present as dull pain, which may be accompanied by oozing or bleeding from the external auditory canal.
Neurological Pain
A key symptom of Hunt syndrome is severe, localized ear pain caused by herpes zoster of the ear, accompanied by congestion in the auricular cavity and vesicular rashes. Trigeminal neuralgia involving the auriculotemporal nerve is characterized by paroxysmal and brief throbbing pain in the external auditory canal. Glossopharyngeal neuralgia manifests as throbbing pain, often with a trigger point in the oropharynx.
Referred Pain
Certain diseases in adjacent areas, such as the teeth, temporomandibular joint, pharynx, larynx, neck, and respiratory or digestive tract, may cause reflexive ear pain via nerves such as the trigeminal, vagus, glossopharyngeal, small occipital, great auricular, or facial nerve. Temporomandibular joint disorders often cause dull pain in the external auditory canal, with tenderness at the temporomandibular joint and malpositioning of the jaw during opening. Inflammatory conditions of the throat, such as tonsillitis, frequently result in referred pain to the external auditory canal.
Ear Discharge
Ear discharge (otorrhea), also referred to as otic effusion, can be classified based on the nature of the discharge, which provides clues for diagnosing ear diseases.
Sebaceous Ear Discharge
Commonly known as "oily ear," this refers to thin, soy-sauce-colored, oily cerumen. This condition is often associated with a wide external auditory canal and is usually linked to racial or hereditary factors.
Serous Ear Discharge
This is a thin, clear, and non-sticky fluid often observed in conditions such as eczema of the external auditory canal or allergic otitis media.
Mucous Ear Discharge
This thick, viscous discharge is typically seen in the early stages of chronic suppurative otitis media. It may also appear in secretory otitis media following myringotomy or insertion of a tympanostomy tube. In rare cases, it can result from a branchial cleft fistula.
Watery Ear Discharge
This type of discharge often indicates cerebrospinal fluid otorrhea, which may occur after temporal bone trauma or middle or inner ear surgeries.
Purulent Ear Discharge
This type is commonly associated with acute or chronic suppurative otitis media, furuncles, or diffuse inflammation of the external auditory canal. Secretions from purulent middle ear inflammation often transition from being viscous to mucopurulent and subsequently to purely purulent.
Bloody Ear Discharge
Conditions such as bullous myringitis, cholesterol granuloma of the middle ear, middle ear carcinoma, jugular body tumors, or cholesteatoma with granulation formation in the middle ear can lead to bloody otorrhea.
Hearing Loss
Hearing loss refers to the totality of hearing impairments caused by structural or functional abnormalities of the auditory system and the auditory conduction pathway. The causes and clinical manifestations of hearing loss are highly diverse. Hearing loss can be classified based on the location, nature, or onset characteristics of the condition.
Classification by Location of the Lesion
Hearing loss caused by abnormalities in the external or middle ear sound-transmitting structures is classified as conductive hearing loss.
Damage to the spiral organ of Corti in the cochlea results in sensory hearing loss.
Lesions occurring from the spiral ganglion to the cochlear nuclei in the brainstem are classified as neural hearing loss.
Disorders along the pathway from the cochlear nuclei to the auditory cortex are referred to as central hearing loss, which may also include some cases of psychogenic hearing loss.
Clinically, hearing loss is generally categorized into conductive hearing loss, sensorineural hearing loss (a combination of sensory hearing loss and neural hearing loss), and mixed hearing loss (a combination of conductive and sensorineural components).
Classification by Nature of the Lesion
Hearing loss may be classified as organic (resulting from structural abnormalities) or functional (resulting from non-organic factors).
Classification by Onset Characteristics
Hearing loss may present as sudden, progressive, or fluctuating over time. It may also be classified as congenital or acquired based on the timing of onset.
Tinnitus
Everyone experiences physiological tinnitus to some extent. When it exceeds normal physiological limits, it becomes a symptom. Identifying tinnitus as a symptom requires excluding auditory hallucinations and head noise. Patients with conductive hearing loss often experience low-pitched tinnitus, resembling a machine's humming. Patients with sensorineural hearing loss typically experience high-pitched tinnitus, similar to cicada chirping. Tinnitus can also result from disorders in adjacent structures of the ear or systemic diseases. In some cases, no underlying pathological changes can be identified, and the condition may be influenced by factors such as rest and emotions.
Objective Tinnitus (also known as Non-Subjective Tinnitus)
Vascular-Related Tinnitus
This occurs due to abnormalities such as arteriovenous fistulas around the ear.
Myogenic Tinnitus
This is caused by muscle spasms such as palatal muscle spasms or stapedius muscle spasms, producing a "clicking" or spasm-like sound.
Aerodynamic Tinnitus:
This results from abnormal patency of the Eustachian tube, producing a breathing airflow sound.
Other Causes
Sounds originating from the temporomandibular joint, such as noises caused by laxity of the joint capsule, may be misinterpreted as coming from the ear.
Objective tinnitus is relatively rare, and its causes are often identified through otoscopic examinations.
Subjective Tinnitus
Tinnitus Caused by Ear Diseases: Common causes include cerumen impaction, non-suppurative or suppurative otitis media, Eustachian tube obstruction, otosclerosis, Ménière's disease, acoustic neuroma, noise-induced hearing loss, ototoxic hearing loss, and presbycusis. Tinnitus due to Ménière's disease tends to worsen during episodes of vertigo.
Tinnitus Caused by Systemic Diseases
Common causes include hypertension, hypotension, atherosclerosis, anemia, leukemia, kidney diseases, diabetes, toxemia, poisoning, and menopause.
Tinnitus Caused by Psychological Factors
This includes factors such as work-related stress and emotional distress.
Tinnitus Caused by Other Factors
This includes excessive smoking and alcohol consumption, as well as sleep disturbances.
The prevalence of tinnitus caused by non-otogenic factors, such as psychological issues and sleep disturbances, has been increasing significantly in recent years.
Vertigo
Vertigo refers to a spatial disorientation that results in a false perception of motion or positional changes of the body or the environment. More than 70% of vertigo cases are peripheral in origin, caused by peripheral vestibular dysfunction. Peripheral vertigo generally manifests as a spinning sensation of the surroundings with eyes open and a sensation of self-rotation with eyes closed.
Peripheral Vertigo
Peripheral vertigo often has a sudden onset and is characterized by rotation or swaying of oneself or the surrounding visual field. It is often associated with changes in head position and may be accompanied by tinnitus, hearing loss, and rhythmic nystagmus. Each episode usually lasts from several minutes to several hours, rarely exceeding a few days. It tends to resolve on its own but has a tendency to recur. Common causes include Ménière's disease, labyrinthitis, and ototoxic drug poisoning. Peripheral vertigo is often accompanied by autonomic symptoms such as nausea, vomiting, and cold sweats. Benign paroxysmal positional vertigo (BPPV) is characterized by episodes lasting from a few seconds to several tens of seconds, with a clear relationship to head position changes. Vertigo due to superior semicircular canal dehiscence is often triggered by loud sounds.
Central Vertigo
Central vertigo typically has a slower onset and manifests as a sensation of swaying or floating, with little perception of rotational movement of the surroundings. It is not associated with changes in head position. Central vertigo is usually not accompanied by tinnitus or hearing loss but is often associated with other central nervous system symptoms and various types of nystagmus. The course of the disease tends to be longer and may last several weeks or more. Common causes include acoustic neuroma and cerebrovascular diseases. Central ischemic vertigo often presents with symptoms such as transient blindness or visual flickering. While vertigo symptoms are typically milder in central vertigo, balance disturbances and gait instability are more prominent.
Systemic Disease-Related Vertigo
Vertigo caused by systemic diseases can vary in presentation and may include sensations such as floating, numbness, tilting, or linear motion illusions. This form of vertigo is commonly observed in conditions such as hypertension, severe anemia, heart disease, post-traumatic brain injury, hypoglycemia, and neuroses. Cervical vertigo is characterized by episodes of fainting or vertigo following neck rotation.