HEADACHE.COM.AU

Outer Ear

The ear is generally described in three parts: outer, middle and inner. Different conditions can affect each of these separately or can progressively involve all parts of the ear bone and its surrounding structures. Pain , especially constant or worsening pain about the ear, is a serious symptom and must be carefully assessed to exclude potentially very dangerous conditions.

Otalgia may be primary (from the ear structures themselves) or referred (from other, generally nearby, structures)

Primary causes of otalgia involving the Outer Ear are described below:

Infection = Otitis Externa

Acute

Also called swimmerís ear or tropical ear

Presents with hearing loss, ear discharge, and pain in the ear radiating to surrounding scalp, jaw and neck

Treated with suction cleaning under direct vision and antibiotic and anti-inflammatory ear drops, keeping ear dry, pain killers.

Chronic

Similar symptoms to above.

Often secondary to untreated or poorly treated acute otitis externa

Often associated with unnecessary self instrumentation (cotton buds, hair clips, etc - the ear canals are self cleaning and do not require cleaning in majority of individuals), underlying skin disease, dermatitis or psoriasis

Similar treatment to acute condition but generally more prolonged recovery time

Trauma

Laceration and fractures, ear drum perforation

Foreign body

Seeds, insects, toy parts, metal fragments (endless list !!)

Benign and malignant tumours

Rare and treated with surgery and radiotherapy

Ear, Nose and Throat Problems may contribute to Headaches and Migraines so it is important to have them professionally addressed. It is also important to investigate for other potential causes, as many cases of Headaches and Migraines have more than one ingredient.

See Treatments Section

Author:

Middle Ear

The ear is generally described in three parts: outer, middle and inner. Different conditions can affect each of these separately or can progressively involve all parts of the ear bone and its surrounding structures. Pain , especially constant or worsening pain about the ear, is a serious symptom and must be carefully assessed to exclude potentially very dangerous conditions.

Otalgia may be primary (from the ear structures themselves) or referred (from other, generally nearby, structures)

Primary causes of otalgia involving the Middle Ear are described below:

Infection = Otitis Media

Acute

Pain, deafness and often discharge (which often results in sudden decrease in pain)

Common in young children, less common in older children and adults, often following colds, etc

Treated with antibiotics, pain killers, decongestant tablets and nasal sprays

Recurrent episodes may warrant ventilation tubes (grommets or tympanostomy tubes) which are inserted into the ear drum

Chronic

Similar symptoms to acute otitis media but more prolonged course (> 3 months)

More likely to cause complications either within the ear (chronic discharge, permanent deafness, balance disturbance, facial paralysis) or outside the ear (meningitis, brain abscess, hydrocephalus, death)

Commonly associated with cholesteatoma, a condition where skin of the ear canal grows into the middle ear and slowly destroys the structures of the ear.

Quite complex surgery is often required to manage chronic otitis media

Inflammations

Autoimmune disease such as Wegener's Granulomatosis

Tumours

Benign and malignant - not all that common

Trauma

Ear drum perforation (blows to the ear, water skiing, explosive blast injuries, foreign body, etc.)

Temporal bone fractures from vehicle accidents (somewhat obvious!)

Ear, Nose and Throat Problems may contribute to Headaches and Migraines so it is important to have them professionally addressed. It is also important to investigate for other potential causes, as many cases of Headaches and Migraines have more than one ingredient.

See Treatments Section

Author:

Inner Ear

The ear is generally described in three parts: outer, middle and inner. Different conditions can affect each of these separately or can progressively involve all parts of the ear bone and its surrounding structures. Pain , especially constant or worsening pain about the ear, is a serious symptom and must be carefully assessed to exclude potentially very dangerous conditions.

Otalgia may be primary (from the ear structures themselves) or referred (from other, generally nearby, structures)

Primary causes of otalgia involving the Inner Ear are described below:

Labyrinthitis

This is the term given to inflammation of the inner ear from any cause. Patients present with acute or recurrent dizziness, hearing loss, tinnitus and, in severe cases, pain.

Non infectious (inflammatory, autoimmune, etc)

Infectious (viral and bacterial)

Can be treated with pain killers, anti-inflammatories, antibiotics, steroids. In some cases nothing can be done and the illness has to be left to run its course. The ear may or may not recover, leaving the patient with deafness, tinnitus or balance disturbance.

Acoustic Neuroma/Vestibular Schwannoma

Benign tumour of the nerve of hearing and balance which presents with one sided deafness, balance disturbance, tinnitus ("ringing noises in the ear"), and in longstanding larger tumours, face weakness and headache

Facial Nerve Tumour

The facial nerve controls motion of face muscles and damage to it from any cause can result in paralysis of the face. The nerve reaches the face by passing through the ear bone.

Primary facial nerve tumours which are rare and often similar to acoustic neuromas but patients generally present with facial weakness and later hearing and balance problems. May be malignant and present with pain

Secondary facial nerve tumours which are malignant and originate from surrounding structures and patients present with facial weakness and pain

General Tumours

Generally rare malignant tumours, often spreading from other parts of the body

The petrous apex is the inner most part of the ear (temporal) bone. A variety of rare infections, inflammations, tumours, etc can occur here and cause ear pain

Please Note:

Most of the above conditions are rare and require specialised assessment, investigation and treatment.

Ear, Nose and Throat Problems may contribute to Headaches and Migraines so it is important to have them professionally addressed. It is also important to investigate for other potential causes, as many cases of Headaches and Migraines have more than one ingredient.

Author:

See Treatments Section

Referred Pain

Ear pain is known as otalgia The ear is generally described in three parts: outer, middle and inner. Different conditions can affect each of these separately or can progressively involve all parts of the ear bone and its surrounding structures.

Pain, especially constant or worsening pain about the ear, is a serious symptom and must be carefully assessed to exclude potentially very dangerous conditions.

Otalgia may be primary (from the ear structures themselves) or referred (from other, generally nearby, structures)

Common sites of referred otalgia (pain travelling to the ear) include:

• the cervical spine (associated neck bones, nerves, muscles and ligaments)
• the jaw joint
• the teeth
• the lymph and salivary glands of the neck (especially the parotid gland)
• the nose and sinuses
• the tonsils, tongue and larynx (voice box)
• structures inside the skull related to the brain and its protective covering(the meninges).

See Relevant Sections (for more information on sources of referred pain)

Ear, Nose and Throat Problems may contribute to Headaches and Migraines so it is important to have them professionally addressed. It is also important to investigate for other potential causes, as many cases of Headaches and Migraines have more than one ingredient.

See Treatments Section

Author:

See Treatments Section

General Ear Problems

Headache Secondary to Diseases of the Ear, Nose & Throat Headache

Introduction

In preparing notes for a lay persons web site about the ear, nose and throat causes of headache, one must appreciate that only a brief and incomplete description of the causes, clinical presentation, investigation and management of these conditions can be provided.

Further information can be obtained by searching key conditions either on the web or via libraries, textbooks, scientific journals, etc, or by seeking expert advice from suitably qualified health professionals.

On no account should any individual make any assumptions about symptoms they or others have based on the general information provided at this website. Patients with persistent symptoms should always seek appropriate advice from suitably qualified health professionals.

There is considerable overlap between the various health professionals in the management of patients presenting with headache and it is not uncommon for two or more experts to be involved in the care of some patients.

I hope those of you taking a look at this site find the following information useful, if not a little dry !! Remember that the objective of this site is to educate patients and other interested persons about the possible causes of headache. Don't expect an exhaustive account about each topic.

Pain causing headache is a common symptom for which there are many causes. From the perspective of the Ear, Nose and Throat Surgeon, such conditions are best described based on regional causes, i.e., the ear; nose and sinuses; and neck, including throat.

Author:

Mr Anthony J. Guiney MBBS FRACS

Ear, Nose, Throat, Head & Neck Surgeon

Consultant Surgeon, Mercy Private Hospital and Rhinology Unit (Nose & Sinus Clinic), Royal Victorian Eye & Ear Hospital

Member Australian Society of Otolaryngology, Head and Neck Surgery

Member Australian Association of Facial Plastic Surgeons

General & Paediatric Ear, Nose & Throat Surgery

Head & Neck Surgery including Thyroid & Parotid Surgery, Reconstructive Plastic Surgery

Audiology Assessments

Medicolegal, TAC & Workcover Assessments (Registered Impairment Assessor)

Special Interests:

Nose & Sinus Surgery

Rhinoplasty & Otoplasty, Facial Skin Malignancy

Sleep Disordered Breathing (Management of Snoring & Sleep Apnoea)

Voice Disorders & Phonosurgery

Contact Details

See Treatments Section