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Full text of "Diseases Of The Nose Throat And Ear"

CHAPTER 50
OTALGIA

If a patient complains of earache the cause is usually determined by inspection
of the external meatus and the tympanic membrane, but in a number of cases
the pain is a referred one and the meatus is healthy and the drumhead normal.
It is important that otoscopy is honestly conducted and that the examiner
does not persuade himself that he is seeing pathology where none exists,
otherwise both diagnosis and treatment will be incorrect. The ear receives
sensory nerve supply from the trigeminal, glossopharyngeal and vagus nerves
and from branches of the upper cervical roots, especially C2 and C3, and when
otoscopy is normal the cause of the pain must be sought in the scalp, neck,
nose, nasopharynx, pharynx, teeth, temporomandibular joint and larynx.

Dental otalgia. Dental pain may be referred through the trigeminal nerve to
the ear. It originates in diseases of the molar teeth, e.g. pulp space infection,
periodontal infection, impacted unerupted teeth—especially wisdom teeth,
carious roots, etc. Even if the patient is edentulous dental radiography may
reveal a retained root or an unerupted tooth. Pain in the ear may follow
dental extraction, or arise from resorption of the lower jaw after clearance of
the teeth. The latter is most often found in women who, for the sake of
vanity, retain *heir dentures day and night.

The temporomandibular joint is a fairly common source of otalgia, and the
cause is a capsular stress produced by dental malocclusion. It may be found in
young people as a result of faulty mastication or incomplete eruption of the
molar teeth so that there is overclosure of "the bite. Badly fitting dentures
throw a strain on the joint capsule, as does injury to the mandible. In 20 per
cent of cases the pain is referred to the ear or the side of the face. Examination
of the joint includes listening for a clicking sound on opening the mouth. The
mandibular condyle should be palpated during jaw movements, and digital
pressure during movement may produce the pain. There may be limitation or
asymmetry of movement, and there is limitation of side-to-side movement of
the opened mandible. Radiography of the temporomandibular joints may
show no abnormality, but this does not exclude the joint as the source of the
pain. The treatment lies in the hands of the experienced dental surgeon who
may manipulate the joint in acute cases with immediate relief, or correct the
bite or change the dentures in long-standing cases.

Pharyngeal causes of otalgia include acute tonsillitis, peritonsillar. abscess,
postjonsillectomy pain? ulcers in the mouth and pharynx, malignant disease
~^J:5|lSi^                                                   The patKway 6f"iri6st of

these is the glossopharyngeal nerve. Glossopharyngeal neuralgia is a primary
neuralgia causing intermittent, agonizing paroxysms of pain affecting the
base of the tongue, the fauces and the ear. The spasms are provoked by
swallowing, talking or coughing, and the pain is unilateral. Treatment by

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