What Causes Ear Pain when Swallowing?

Otitis media is an inflammatory disease that affects all or part of the structure of the middle ear (including the eustachian tube, tympanic cavity, tympanic sinus, and mastoid air cell), and is common in children. Can be divided into non-purulent and suppurative two categories. Non-purulent patients include secretory otitis media, barotrauma otitis media, etc., purulent patients are divided into acute and chronic. Specific inflammation is too rare, such as tuberculous otitis media.

Basic Information

English name

otitis media

Visiting department

ENT

Multiple groups

child

Common causes

Common pathogenic bacteria are mainly pneumococcus, Haemophilus influenza, etc.

Common symptoms

Mainly manifested as earache, pus, tympanic membrane perforation, hearing loss, etc.

Causes of otitis media

1. Acute otitis media is an acute purulent inflammation of the middle ear mucosa, which is infected by the eustachian tube route. Inflammation of the pharynx and nose spread to the eustachian tube after a cold, and congestion and swelling of the eustachian tube and the mucosa of the lumen, ciliary movement disorders, causing otitis media. Common pathogenic bacteria are mainly pneumococcus and Haemophilus influenzae.

2. Nasal mucus contains a large number of viruses and bacteria. If both sides of the nostrils are pinched and pressed hard, the pressure will force the nose to squeeze out the posterior nostril and reach the eustachian tube, causing otitis media.

3. Avoid swallowing the pharynx in the mouth when swimming to avoid water entering the middle ear through the nasopharynx and causing otitis media. Traumatic tympanic membrane perforation is forbidden to drip any watery liquid, so as not to affect wound healing. A sterile cotton ball can be used to block the external ear canal to prevent infection from otitis media.

4. If infants and young children are supine to feed, because the eustachian tube of the infant is relatively straight, and the lumen is short, and the inner diameter is wide, the milk can be sucked into the middle ear through the eustachian tube to cause otitis media.

5. Smoking, including second-hand smoke, can also cause otitis media. Smoking can cause systemic arteriosclerosis, especially nicotine in cigarettes entering the blood, causing spasm of small blood vessels, increasing blood viscosity, sclerosis of the arteries supplying blood to the inner ear, causing insufficient blood supply to the inner ear and severely affecting hearing.

6. If you listen to large decibel music with headphones for a long time, if you take a long time, it can easily cause chronic otitis media.

Otitis media clinical manifestations

Pyogenic otitis media

(1) Acute suppurative otitis media The inflammation of the middle ear caused by pyogenic bacterial infection, the main symptoms of which are ear pain and purulent discharge. Children's systemic symptoms are more obvious than adults, and they may have fever and vomiting. Serious complications include intracranial complications such as meningitis and brain abscess. Other complications include labyrinthitis and facial paralysis.

(2) Chronic suppurative otitis media refers to chronic suppurative inflammation of the middle ear mucosa, periosteum, or deep bone. The disease is more common clinically, and the main clinical manifestations are intermittent or continuous pus discharge in the ear, tympanic membrane perforation, and hearing loss. It can cause intracranial and extracranial complications in severe cases. Systemic symptoms vary in severity. May be afraid of cold, fever, fatigue, loss of appetite. Children with severe systemic symptoms are often accompanied by vomiting, diarrhea and other gastrointestinal symptoms. Once the tympanic membrane is perforated, the body temperature gradually decreases and systemic symptoms are significantly reduced. Ear pain The pain in the deep ear gradually worsens. If pulsating throbbing or tingling, radiate to the head or teeth on the same side. Ear pain worsens when swallowing and coughing. Those with severe ear pain cannot sleep at night and are restless. After the tympanic membrane perforates and pus, ear pain subsides. ear pus is the main symptom of this disease, which can be mucus, mucus or pure purulent. Non-dangerous pus is thin and odorless. Although there is not much dangerous pus, but it is thick, mostly pure purulent, and accompanied by peculiar smell. Hearing loss and tinnitus Began to feel ear tightness, followed by hearing loss with tinnitus. Deafness in earache drama can be ignored. Some patients may be dizzy, and deafness may be reduced after perforation. Deafness varies in severity, because it is mostly monotonic, and it is easy to be ignored. It is usually conductive deaf.

2. Non-purulent otitis media secretory otitis media.

(1) Hearing loss Most acute secretory otitis media can occur after a cold, when descending by plane or diving, and hearing loss may occur, and there may be a "sound enhancement" phenomenon. The severity of deafness in patients with chronic secretory otitis media often fluctuates. When the tragus is pressed or the head position is changed, the hearing can be improved. When the middle ear effusion is thick, the hearing will not change due to the change of the head position. The main complaints of children with hearing loss are manifestations of neglect of parental calls, lack of concentration, or excessive volume when watching television.

(2) Earaches There may be slight earaches in acute secretory otitis media, and earaches in chronic secretory otitis media may occur in secondary infections.

(3) A feeling of stuffiness or occlusion in the ear.

(4) Tinnitus is generally not heavy, and may be intermittent. When the head is moved, yawning, or blowing your nose, you can hear the sound of breath. A small number of patients with secretory otitis media may also have water in the ear, but the duration is very short, only a few hours or about a day.

(5) Otoscope examination There are radial vascular veins around the eardrum in the acute stage. The tension of the tympanic membrane is indented, manifested by the shortening, deformation or disappearance of the light cone; the malleolus stem is shifted backward and upward; the short protrusion of the malleus is obvious. The tympanic membrane loses its normal luster when the tympanic effusions are pale yellow, orange-red, or amber. Chronic tympanic membranes are milky white or gray-blue, opaque. If the secretion is serous and does not fill the tympanic cavity, the liquid level can be seen through the tympanic membrane, which is a curved line with a concave surface upward. Sometimes bubbles can be seen through the tympanic membrane. If there is more fluid, the tympanic membrane protrudes and the tympanic membrane mobility is limited.

Otitis examination

Tympanic membrane

The sagging part or the whole tympanic membrane is indented. The light cone is shortened, deformed, or disappeared. The malleolus stem is shifted backwards and upwards. The tympanic membrane loses its normal luster when the tympanic fluid accumulates, showing a single yellow, orange-red, or amber color, with the light cone deformed or displaced. Chronic patients can be gray or milky white, with dilated microvessels in the tympanic membrane tension, short protrusions more chalky, and sacrum handles embossed. If the liquid is serous and does not fill the tympanic cavity, the liquid level can be seen through the tympanic membrane. This liquid surface is like a curved hairline, called a hairline, with the concave side facing up. When the head position changes, its parallel relationship with the ground remains unchanged. Air bubbles can be seen through the eardrum, and the air bubbles can increase after the eustachian tube is stretched. Otoscopy of the tympanic tympanum showed limited tympanic membrane activity.

2. Corkscrew

After pressing the tragus separately, the speed was released, and the two ears were tested separately. The patient consciously heard that the ear had a sound similar to that when the bottle stopper was pulled out.

3. Hearing test

Tuning fork test and pure music listening valve test showed conductive deafness. Hearing loss varies, with severe cases reaching around 40dB HL. Hearing impaired persons should undergo an auditory brainstem response and otoacoustic emission tests to determine if they affect the inner ear.

4.CT scan

It can be seen that the air cavity of the middle ear system has increased density in different degrees.

Otitis Media Treatment

1. Actively treat upper respiratory tract infectious diseases

Such as chronic sinusitis, chronic tonsillitis.

2. Drug treatment

The simple type is mainly for topical use. It can be treated with antibiotic aqueous solution or a mixture of antibiotic and steroid hormone drugs, such as 0.25% chloramphenicol solution, chloramphenicol cortisone solution, ofloxacin ear drops, etc. Yan and so on.

3. Precautions for topical use

(1) Before using the medicine, first clean the pus in the external auditory canal and middle ear cavity. You can use 3% hydrogen peroxide or boric acid water, and then wipe it with a cotton swab or suck up the pus with an aspirator before dripping the medicine.

(2) When the amount of pus is large, use water. When the amount is small, use borate alcohol.

4. Large tympanic membrane perforation affects hearing, and tympanic membrane repair or tympanoplasty is feasible.