(1) Primary earache
It's earache caused by ear disease.
1, ear lesions
Inflammation and trauma: patients can directly see the lesions.
2. External auditory canal lesions: Earache caused by external auditory canal lesions is aggravated when the patient presses the tragus or pulls the auricle.
The main examination method: the diagnosis can be made by general examination in outpatient department without special examination.
A, inflammatory infection: mostly acute symptoms.
B, injury: most of them have a history of ear digging.
C. foreign body: there is a history of foreign body entering the ear (children can't say it, or they may not have this history).
D, cerumen embolism: easy to cause infection and earache. It may be accompanied by hearing impairment, or there is a murmur in the ear when the position changes.
3, middle ear lesions: when pressing the tragus or pulling the auricle, the pain is not aggravated.
Examination method: if non-suppurative otitis media is suspected, electrical audiometry and acoustic impedance examination can be carried out; If suppurative otitis media is suspected to be a chronic disease, CT examination is feasible; For acute lesions, general examination is enough, and no special examination is needed, but CT examination is needed when necessary.
A otitis media and acute suppurative otitis media: new onset, severe or severe pain, which may be accompanied by fever.
B, chronic suppurative otitis media: causing acute attack or aggravating symptoms to cause ear pain. It is often accompanied by a long-term disease with pus in the ear. X-ray or CT examination.
C, middle ear tuberculosis: the pain is mild, the course of disease is long, and there is often pus, which can't be cured for a long time. Need to carry out bacterial culture inspection.
D, middle ear cancer: the pain is lighter during the day and heavier at night. Accompanied by long-term pus in the ear, or pus with blood CT photos and pathological examination.
(4) Periodontal disease
Inflammation and lumps around the ears: patients can see or perceive the lesions around the ears by themselves. There is an inflammatory mass, which can disappear or become significantly smaller after treatment with anti-inflammatory drugs; If it is a tumor, it is ineffective for anti-inflammatory drugs, and pathological examination can be done.
(2) Affected earache
It is a disease of other parts of the body, an ear disease caused by nerve reflex. It is characterized by transient or epileptic pain, no obvious regularity and no ear lesions.
Examination method: General examination of throat and mouth is mainly carried out.
1, acute inflammation of throat:
I feel the heartache in my ears. The pain is heavy and short-lived. At the same time, there is obvious pharyngeal pain and dysphagia.
2, oral lesions:
It exists in dental diseases, periodontal diseases, pulp diseases, jaw diseases and so on.
3, nasal lesions:
Accompanied by nasal symptoms.
4, other lesions:
A glossopharyngeal neuralgia and trigeminal neuralgia: there is severe pain in the throat or face.
B. Carotid inflammation: there is tenderness at the pulsation of one or both carotid arteries.
Second, the ears are swollen.
1, periauricular swelling (periauricular swelling)
(1) Extensive swelling of the head, face and ears: In severe cases, the eyes are swollen and closed, and they can't open their eyes, which are mostly caused by severe allergic reactions, such as eating certain foods or touching certain substances.
(2) swelling of the skin around the ear: inflammation of the skin around the ear, visible to the patient, congestion, pain when touching pressure, such as the size of beans, black spots on the surface, mostly sebaceous cyst (which can be cured by surgical incision); If there are blisters and erosion, it is mostly ear eczema.
(3) Periauricular lymphadenopathy: It is mostly caused by inflammation around the ear or pharynx, and swollen lymph nodes may have tenderness.
(4) Parotid gland enlargement: located below the earlobe and at the mandibular angle. Generally belongs to the field of stomatology.
2. Ear swelling:
(1) Ear swelling and pain: inflammation and infection. It should be treated actively to avoid the formation of suppurative otitis media, leading to auricle cartilage necrosis and auricle deformity.
(2) Ear cavity swelling: if it is found by chance that the size of soybean is larger or larger, it is painless, slightly swollen, not red, or slightly itchy and uncomfortable, and it is elastic, mostly pseudocyst of auricle.
3, swelling of the external auditory canal: common in otitis externa or furuncle of the external auditory canal.
Otitis externa is accompanied by earache, and a little secretion in the external auditory canal is sticky.
When the external auditory canal boils, the external auditory canal is locally red and swollen, and the earache is severe or severe. When furuncle swells into pus, there is a yellow-white pus embolism on the local swollen surface, such as pepper.
Third, my ears itch.
In general, no special inspection is required.
1, itchy skin around ears:
A. Allergic diseases: The auricle is normal locally, with symptoms of allergic rhinitis.
B, inflammation, eczema: there is inflammation around the ear, which can be seen by patients. Sometimes the local skin is rough and desquamation (chronic eczema).
2. Itching of external auditory canal
A, eczema, chronic inflammation of the external auditory canal: the external auditory canal is narrow, itchy and painful when scratching, or causing bleeding and spilling a small amount of fatty water.
B, external auditory canal mycosis: there is mold growth in the external auditory canal, gray.
C, unexplained itching (taking traditional Chinese medicine is effective)
Fourth, the feeling of swollen ears.
1, non-suppurative otitis media: electrical audiometry and acoustic impedance examination are feasible.
Due to eustachian tube obstruction. The swelling and tightness in the ear are obvious, which may be accompanied by tinnitus, or mild hearing impairment (sometimes difficult for patients to detect), or tympanic membrane invagination and eustachian tube dysfunction (acoustic impedance test results). Sometimes it is accompanied by symptoms such as nasal congestion, nasal discharge and nasopharyngeal discomfort.
2. Abnormal opening of eustachian tube: electrical audiometry and acoustic impedance examination are feasible.
There may be a feeling of swelling in the ears, which may be accompanied by tinnitus (deep inhalation or exhalation through the nasal cavity, which may be accompanied by snoring in the ears).
3. Nasopharyngeal carcinoma: fiberoptic bronchoscopy, CT examination and pathological section examination are feasible. The final result is subject to the results of pathological section examination.
Caused by the compression of eustachian tube. After nasal inhalation, it may be accompanied by spitting, blood in sputum and nasopharyngeal discomfort.
3, Meniere's disease:
The feeling of swelling in the ears may be a signal that the disease is about to attack. Have a history of recurrent sudden dizziness.
4. Nerve deafness caused by virus infection:
Most of them have a recent history of respiratory infection or cold, accompanied by obvious sensorineural hearing loss (audiometry results).
5. sudden deafness.
6. others.
Five, the tympanic membrane invagination: the outpatient doctor can know at a glance, and no special examination is needed. If necessary, the eardrum can be examined by an electron microscope.
It is an important sign of non-suppurative otitis media. It can be seen in both acute and chronic stages. Non-suppurative otitis media mainly caused by colds, especially those who have repeated colds, are more likely to appear. Because most people have a cold experience, most people are likely to have an eardrum invagination. Generally, it can only cause mild hearing loss, and most of them will not affect normal daily conversation. It can be recovered after treatment, but it is difficult to completely return to normal.
When the eardrum invaginates, you can massage the eardrum or blow the eustachian tube yourself, which will help the eardrum return to normal. Method:
(1) tympanic membrane self-massage
Stick the palms of two hands on the ear holes and press them again and again, so that the air will be released after entering the external auditory canal, thus making the tympanic membrane move inward and outward. This is tympanic membrane massage. Because the patient did it himself, it is called self-tympanic membrane massage.
(2) Self-expanding eustachian tube
Hold two nostrils with one thumb and forefinger (also called forefinger) and close your lips to prevent air from escaping. Then air is blown out from the lungs, and then blown out one after another (for a long time), so that the air consciously enters the eustachian tube at the back of the nasopharynx and enters the middle ear cavity. Air enters the middle ear cavity, and the ear that enters the air has a sense of occlusion, and the hearing suddenly drops. After repeated blowing several times, pause again to let the air out of the middle ear cavity, and then the hearing will return to its original state. So many threads a day will help the sunken eardrum return to normal.
Precautions:
A, when there is acute inflammation in the nasal cavity, especially when you can't hear the secretion, you should not blow it when you add it to the nose, so as not to blow the secretion to the middle ear and cause contralateral inflammation.
B, don't lift the soft palate when blowing, the soft palate will naturally relax, otherwise the soft palate will hold the nasopharynx and air can't enter the middle ear cavity.
Intransitive verb ear secretion (ear secretion)
(A) the nature of earwax
1, purulent secretion: thick and turbid, mostly yellow.
2, mucus purulent secretion: sticky, mostly yellow and white.
3, mucinous secretions: sticky, mostly white.
4, water secretion: clear water, colorless.
5, bloody secretions: pure blood, or blood in the secretion.
6, dry and cool: if the cheese is cold, or bean dregs, black or dark brown, how smelly.
(2) Common ear wax diseases
1, acute suppurative otitis media
New onset, history of earache, pus outflow after tympanic membrane perforation, mostly purulent or viscous, with a large amount.
2. Chronic suppurative otitis media
The course of chronic disease or acute suppurative otitis media is more than 8 weeks. There is soup secretion in the ear, mostly viscous or mucinous, and the tympanic membrane is perforated.
3. Cholesteatoma otitis media (requiring CT or X-ray examination)
Most of them are cheese-like secretions, with a small amount, but they rarely flow out on their own, with a bad smell and a long course of disease.
4. Non-suppurative otitis media (audiometry and acoustic impedance examination)
Because there is exudate in the ear after tympanic membrane catheterization, most of them are watery secretions.
5. Cerebrospinal fluid otorrhea (laboratory examination)
There is a clear watery object flowing out of the ear, and there is no otitis media. Mainly seen in newborns and after craniocerebral trauma.
6. Tuberculous otitis media (pathological examination and bacterial culture examination)
Secretion is like suppurative otitis media, which cannot be cured by long-term treatment. There are edema and pale changes in tympanic mucosa.
7, middle ear cancer (CT examination, pathological examination)
Bloody secretion.
Seven, tympanic membrane perforation (at a glance)
There are three main reasons for tympanic membrane perforation, one is suppurative otitis media, the other is tympanic membrane trauma, and the third is non-suppurative otitis media, when doctors cut the tympanic membrane or puncture the tympanic membrane (this is a medical necessity).
If the condition improves, the perforation can heal itself.
If the tympanum is dry or there is no external inflammation, if it is not well protected, it will lead to sewage entering the ear and forming suppurative inflammation.
note:
1. If the perforation of tympanic membrane is caused by trauma or incision or puncture, never drop medicine into the ear, otherwise there will be infection in the middle ear cavity.
2. Perforation caused by suppurative otitis media, if there is no suppuration for a long time and the tympanum is dry, it is not allowed to enter any liquid substance, otherwise it will easily cause middle ear cavity infection.
Eight, tinnitus, cranial sound (brain sound)
1, external auditory canal diseases:
Cerumen embolism, foreign body in external auditory canal: when the head position changes, something in the ear causes noise; Or tinnitus accompanied by earache and dizziness (earwax or foreign bodies touch the eardrum, stimulate nerves to cause pain, and nerve reflex causes transient dizziness).
2. Middle ear diseases:
A. Non-suppurative otitis media: low-pitched tinnitus with ear swelling and stuffy ears. (Electrical audiometry, acoustic impedance inspection)
B. Chronic suppurative otitis media: Due to diseases such as perforation of tympanic membrane, perforation of tympanic membrane or purulent discharge in ear is more common. (X-ray or CT examination, hearing examination)
C. Ear trauma or perforation of tympanic membrane.
D, otosclerosis.
3, inner ear lesions (nervous tinnitus):
A. All kinds of sensorineural deafness: mostly high-pitched tinnitus. (hearing test)
B, Meniere's disease: there is a history of repeated dizziness, and tinnitus is aggravated during the attack.
C acoustic neuroma: it is a benign intracranial tumor with sensorineural deafness in the ear. When walking, the gait is unstable and it is easy to fall to one side. (electric audiometry; CT examination is necessary)
4. Cervical spondylosis: (CT examination)
Head rotation may be accompanied by dizziness.
5, vascular tinnitus
It belongs to objective tinnitus or heterogeneous tinnitus, and refers to tinnitus caused by vascular diseases. When vascular diseases occur in the brain or neck, such as jugular glomus tumor, carotid body tumor, hemangioma, arteriovenous flaccidity, vascular malformation and so on. Both the patient and the examiner can hear the inner ear sound, and there is a blowing sound synchronized with the pulse movement in the ear or neck auscultation. Special inspection is generally required.
6. Myogenic tinnitus
It belongs to objective or heterogeneous tinnitus, which is mostly caused by muscle clonus near or in the ear. Such as eustachian tube muscle group, palatine sail muscle group or middle ear muscle group, such as stapedial muscle, muscle clonus appears, and a "click" sound can be heard in the ear. This kind of sound can sometimes be temporarily controlled by the patient's consciousness, and acupuncture treatment sometimes produces this effect. Snap-bang temporomandibular joint disease and its sound can sometimes be introduced into the ear, forming synesthesia tinnitus.
7. Respiratory tinnitus
It belongs to objective or heterogeneous tinnitus, which is mainly due to the eardrum response caused by the change of respiratory pressure when the eustachian tube is abnormally opened.
8, diet, life reasons (bad factors):
Excessive irritating foods such as tobacco and alcohol: eating a diet with high cholesterol and high salt can cause or aggravate tinnitus; Some food allergies cause allergic reactions in the body, causing tinnitus; Avoid food can aggravate tinnitus symptoms, but a few can relieve tinnitus; Drinking strong tea, caffeinated drinks and alcohol will aggravate tinnitus. In addition, excessive smoking can also cause or aggravate tinnitus.
Noise: People who often suffer from tinnitus in noisy environment, the time of exposure to noise increases, and the incidence of tinnitus increases. Noise can aggravate primary tinnitus, but it can also alleviate or relieve primary tinnitus, or make another kind of ringing sound mixed with primary ringing sound.
Posture: Most patients have more severe tinnitus when lying down than when standing up, but a few patients feel less tinnitus.
Eye movement: A few patients have tinnitus when they have eye movement or blink. The latter may be caused by the simultaneous excitation of facial nerve and stapedius muscle.
9. Systemic diseases:
Cardiorenal diseases: such as hypertension, nephropathy, arteriosclerosis, etc. This is the most common.
Hematopoietic system, endocrine system, metabolic diseases: anemia, hyperthyroidism, menopausal syndrome, irregular menstruation, vitamin deficiency, hyperlipidemia, etc. For example, women will feel worse earring during menstruation. A small number of pregnant women feel that their ears are getting worse.
Brain diseases and nervous system diseases: cerebral arteriosclerosis, cerebrovascular accident (stroke), brain tumor, brain injury, blast injury, etc.
Senile degeneration: Senile deafness and tinnitus.
Neurasthenia and auditory hallucination: If brain tumor and epilepsy can be ruled out, this tinnitus belongs to psychosis. The patient's performance is auditory hallucination, scolding or music and singing.
Psychological stress: emotional or mental tension, depression, mood swings, etc. It may induce or aggravate tinnitus, and tinnitus itself will cause patients to have bad mood and psychological state, which will lead to a vicious circle and make tinnitus, which was not serious, more serious or even unbearable. Therefore, good mood and psychological state such as relaxation and happiness can alleviate or alleviate tinnitus.
Allergy: Nose allergy can directly or indirectly affect the outer ear, middle ear, inner ear and central cattle, causing tinnitus.
10, iatrogenic reasons:
Drug poisoning and drug side effects. Mainly western medicine, many kinds of western medicine may cause tinnitus. Those Chinese patent medicines related to syndromes may also cause tinnitus.
1 1, the reason is unknown.
Nine, deafness (hearing impairment)
(A) the classification of deafness
1, by time:
A. congenital deafness: It was formed in the mother's womb before birth and had hearing impairment after birth.
B acquired deafness: deafness caused by birth damage or illness after birth.
2. According to the part: (electric audiometry)
A. Conductive deafness: deafness caused by lesions of the outer ear and middle ear.
B, sensorineural deafness: The following three situations can be collectively referred to as sensorineural deafness (the old man's surname is generally called sensorineural deafness)
A. Sensory deafness: deafness caused by cochlear diseases (such as Meniere's disease).
B. Nervous deafness: deafness caused by nerve conduction pathway diseases (such as acoustic neuroma).
C. Central deafness: deafness caused by hearing conduction center or cerebral cortex damage (such as brain atrophy and meningitis sequelae).
C. Mixed deafness: There are both auditory deafness and conductive deafness (which can be caused by non-suppurative otitis media).
3. According to the degree of deafness: (audiometry)
A. Mild deafness: Mild deafness is generally difficult to know. The hearing loss of electric audiometry is less than 30dB.
B, moderate deafness: it is difficult to listen quietly. The hearing loss of electric audiometry exceeds 30dB or reaches 60dB.
C, severe deafness: it is difficult to listen loudly. The hearing loss of electric audiometry exceeds 60dB or reaches 90dB.
D. total deafness: complete loss of hearing, but it is possible to hear thunder or sudden loud noise. The hearing loss of electric audiometry exceeds 90dB.
Several common symptoms of deafness
1, sudden deafness: also known as idiopathic sudden deafness, the cause is unknown, which may be related to blood supply disorder in the inner ear or labyrinthine virus infection. May occur at all ages. It is characterized by rapid and serious unilateral or bilateral hearing impairment, mainly high frequency, which often reaches the limit in seconds, minutes or hours, and then the hearing will not decline. About half of the patients are accompanied by dizziness, nausea and vomiting, which can last about 1 week, similar to Meniere's disease; A few patients may be accompanied by headache, low fever and upper respiratory tract infection.
2, drug-induced deafness: the most common is deafness caused by ototoxic drugs. There are many high-pitched tinnitus, and the hearing loss of both ears appears gradually or suddenly to varying degrees, which can leave permanent deafness. Dizziness in acute poisoning may be accompanied by nausea and vomiting; Chronic streptomycin poisoning is mainly manifested as balance disorder, unsteady walking, staggering gait, body shaking, and even worse when eyes are closed; Or accompanied by dreaminess, headache, dizziness, impatience, forgetfulness, insomnia, fear, paranoia, unresponsiveness and so on. Deafness and tinnitus are the main symptoms of the elderly. Deafness can reach total deafness.
3. Infectious toxic deafness: refers to the ear disease characterized by severe sensorineural deafness in the middle, late or after infectious diseases, which is mostly caused by the virus of acute infectious diseases infecting the inner ear or invading the auditory nerve and/or auditory pathway. Common infectious diseases such as epidemic cerebrospinal meningitis, Japanese encephalitis, measles, scarlet fever, mumps, influenza, ear herpes zoster, viral pneumonia, etc. More common in children, especially children under 2 years old. It is an important cause of acquired deafness or deafness in children.
4. Noise-induced deafness: it is mostly an occupational disease, mostly caused by excessive noise (above 90dB) and long-term degradation of hearing organs. The longer you work in a noisy environment, the more serious your hearing loss will be. The closer the working position is to the noise, the more likely it is to have hearing damage; The older you get, the more likely you are to suffer from noise deafness. In recent years, some young people have been listening to MP3 for a long time or making phone calls every day, resulting in many cases of noise deafness, which should be paid attention to.
First, the ear structure.
The ear consists of three main parts:
1, external ear
Auricle-collects sound and transmits it to the external auditory canal.
Ear canal (external auditory canal)-guiding sound into the ear.
2. Middle ear
Tympanic membrane-converts sound into vibration.
Three small bone chains (ossicles)-malleus, incus and stapes-transmit vibration to the inner ear.
3. Inner ear
Inner ear (cochlea)-contains fluid and highly sensitive cells (hair cells), and has a tiny hair-like structure that can move with sound vibration.
Vestibular system-contains cells that control balance.
Auditory nerve-the wire from the cochlea to the brain.
Second, what are the common ear diseases
1, tinnitus
Tinnitus, as its name implies, is an abnormal sound in the ear, such as cicada singing and buzzing. Tinnitus is usually a sign of deafness. Severe tinnitus will not only affect patients' normal work, life and sleep, but also worsen interpersonal relationships.
2, deafness
Deafness refers to the pathological changes of auditory nerves and centers at all levels in the sound transmission, sensory perception and auditory conduction pathways in the auditory system, which causes hearing dysfunction and produces different degrees of hearing loss. Clinically, it can be divided into conductive deafness caused by external ear and middle ear lesions; Neurodeafness caused by inner ear and auditory neuropathy; Mixed deafness caused by external and middle ear lesions and middle ear auditory neuropathy.
3, otitis externa
Inflammation of the external ear is often caused by the loss of protective function of earwax, such as bacterial and fungal infections caused by soaking in water (swimming) or excessive cleaning of the ear canal. Ear-pulling appliances include cotton swabs, pencil lead, platform pen covers, bamboo, fingers and so on. These instruments are easy to hurt the skin of the external ear, and if they are not clean, they will cause infection. In addition, if there is otitis media, its pus will also infect the skin of the external ear. There is a special case of otitis externa-furuncle, commonly known as ear furuncle, which is very painful because bacteria infect hair follicles to form pustules. If pustule _ extends to the ear shell, it will often cause severe chondritis.
4, itchy ears
There is no skin infection, but the auditory canal often feels like ants walking, which is itchy. It is often caused by dry skin and insufficient moisturizing of earwax, which is a common problem of aging skin.
5. Deformed ears
Ear shell is an essential thing for long-eared animals to survive, and its main function is to collect sound waves to identify the enemy's position in order to cope with strain and save their lives. However, the function of human ear shell is more practical than its appearance. Without it, unless accompanied by the absence of external auditory canal, it will not have much impact on hearing. But if the ear shell is deformed or there is no ear shell, it is really ugly, and patients will also have psychological obstacles. Be sure to have a good plastic surgery. If there is no external auditory canal at the same time, we should try to rebuild the external auditory canal to improve their hearing. The operation of deformed ear is almost the most difficult plastic surgery, which usually requires the cooperation of otologists and plastic surgeons.
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