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Chronic otalgia treatment, sleep too much stroke - For You

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Otalgia is a common complaint of patients presenting to both general practice and otolaryngology clinics.
PATHOPHYSIOLOGY• The sensory innervation of the ear is served by the auriculotemporal branch of the fifth cranial nerve (CN V), the first and second cervical nerves, the Jacobson branch of the glossopharyngeal nerve, the Arnold branch of the vagus nerve, and the Ramsey Hunt branch of the facial nerve.• Neuroanatomically, the sensation of otalgia is thought to center in the spinal tract nucleus of CN V. In some cases, ear pain is classified as primary otalgia, or pain that originates as the result of pathology within the ear itself.
When the ear is the source of the pain (primary otalgia), the ear examination is usually abnormal. Examples of primary otalgia include external otitis, otitis media, mastoiditis, and auricular infections.
Pain that originates within the ear is primary otalgia; pain that originates outside the ear is referred otalgia.

By definition, referred otalgia is the sensation of ear pain originating from a source outside the ear.• To better understand referred otalgia, the physician first must understand the anatomic distribution of nerves associated with the ear. When the ear is not the source of the pain (secondary otalgia), the ear examination is typically normal. Fever, otalgia, headache, irritability, cough, rhinitis, listlessness, anorexia, vomiting, diarrhea, and pulling at the ears are common, but nonspecific symptoms.
Diagnosis of these conditions is fairly straightforward, and standard treatment generally alleviates the problem.
The cause of primary otalgia is usually apparent on examination; the most common causes are otitis media and otitis externa.
However, in up to 50% of adults complaining of ear pain, the pain is the result of referred otalgia arising from non-otological disease.1 Physicians need to keep in mind the unique and complex innervation of the ear and be familiar with the myriad conditions that can result in ear pain in order to accurately diagnosis and treat the source of referred otalgia.

The cause of secondary otalgia is often difficult to determine because the innervation of the ear is complex and there are many potential sources of referred pain. Patients whose history or physical examination increases suspicion for a serious occult cause of ear pain or whose symptoms persist after symptomatic treatment should be considered for further evaluation, such as magnetic resonance imaging, fiberoptic nasolaryngoscopy, or an erythrocyte sedimentation rate measurement. When the cause arises from the ear (primary otalgia), the ear examination is usually abnormal and the diagnosis is typically apparent.

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