Referred Ear Pain

If examination of the drum and meatus is normal in a patient complaining of earache, the pain is referred. Referred ear pain may be from nearby structures such as the temporo-mandibular joint, neck muscles, or cervical spine. It may also be from the teeth, tongue, tonsils, or larynx. Cranial nerves V, IX, and X which supply these sites have their respective tympanic and auricular branches supplying the ear. Earache also frequently precedes a Bell's palsy.

Siegle Speculum
Fig. 1.15 Siegle's speculum has been displaced by the pneumatic otoscope (see Fig. 1.8), but Siegle's speculum with plain (not magnifying) glass is useful to test drum mobility with the microscope.
Ear Examination

Fig. 1.14 Microscope examination of the drum. a Although most drums can be well seen and conditions diagnosed with the auriscope, the increased magnification that is obtainable with the operating microscope and easier instrumentation, make this apparatus standard in any well-equipped outpatient department. A video camera or tutor arm may be attached to the microscope for demonstration.

The auricular branch of the vagus nerve supplies part of the deep meatus and eardrum, as well as some skin in the post auricular fold. Therefore, instrumentation of the ear may produce a sensation of faintness from a vasovagal episode; also a cough may be triggered. Many therefore prefer to have the ear examination with the patient lying down, particularly for procedures such as difficult suction clearance of wax and debris from the deep meatus. Routine examination of the drum with the microscope may be carried out with the patient sitting up (b).

Fig. 1.14 Microscope examination of the drum. a Although most drums can be well seen and conditions diagnosed with the auriscope, the increased magnification that is obtainable with the operating microscope and easier instrumentation, make this apparatus standard in any well-equipped outpatient department. A video camera or tutor arm may be attached to the microscope for demonstration.

The auricular branch of the vagus nerve supplies part of the deep meatus and eardrum, as well as some skin in the post auricular fold. Therefore, instrumentation of the ear may produce a sensation of faintness from a vasovagal episode; also a cough may be triggered. Many therefore prefer to have the ear examination with the patient lying down, particularly for procedures such as difficult suction clearance of wax and debris from the deep meatus. Routine examination of the drum with the microscope may be carried out with the patient sitting up (b).

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