Leech infestation in otolaryngology is sporadically seen in remote area of tropical countries, but the cases are usually not scientifically reported. We are reporting an unusual case of a land leech removal from external auditory canal (EAC)
Earache

BACKGROUND AND OBJECTIVES: Although otalgia is usually associated with ear problems, it may also originate outside the ear. We therefore assessed the clinical characteristics of patients with otalgia. SUBJECTS AND METHODS: We analyzed 294 patients who presented with otalgia. We assessed differences in otalgia between adults and children, differences in otogenic vs. referred otalgia between adults and children, differences between men and women. RESULTS: Of the 294 patients, 208 (70.7%) had otogenic otalgia and 86 (29.3%) had referred otalgia. Hearing disturbance and otorrhea were significantly more common in otogenic otalgia, whereas rhinorrhea, sore throat, and postnasal drip were significantly more common in referred otalgia. Children were more likely to have otogenic otalgia than adults. The proportion of patients with referred otalgia was significantly higher in adults than in children (p<0.05). Otogenic otalgia was more common in men, whereas referred otalgia was more common in women. Among patients with referred otalgia, neuralgia was significantly more frequent in women than in men (p<0.05). CONCLUSIONS: Otogenic otalgia was more frequent in men than in women and in children than in adults, whereas referred otalgia was more frequent in women and adults, indicating that types of otalgia were dependent on age and gender.
Adult ; Child ; Ear ; Earache* ; Female ; Hearing ; Humans ; Male ; Neuralgia ; Pharyngitis

OBJECTIVE: To present an unusual cause of pulsatile tinnitus, presenting in a young adult suffering from chronic recurrent foul-smelling discharge from the same ear.
METHODS:
Design: Case Report
Setting: Tertiary National University Hospital
Patient: One
RESULTS: A 24 year-old woman presented with pulsatile tinnitus on a background of chronic recurrent foul-smelling discharge. Clinico-radiologic findings seemed consistent with a glomus tympanicum coexisting with chronic suppurative otitis media with cholesteatoma. She underwent tympanomastoidectomy with excision of the mass. Histopathologic evaluation revealed the mass to be granulation tissue.
CONCLUSION: Pulsatile tinnitus is rarely associated with chronic middle ear infection. Granulation tissue arising at the promontory may mimic glomus tumors when accompanied with this symptom. Despite this revelation, it would still be prudent to prepare for a possible glomus tumor intraoperatively so that profuse bleeding and complications may be avoided.

Otalgia is a common symptom with diverse causes due to its complex sensory innervations. It can be broadly classified into two groups. Primary (otogenic) otalgia is defined as pain resulting from ear diseases and secondary (referred) otalgia arises from pathologic processes and structures other than the ear. Its workup is complex and no simple algorithm exists. In this review, authors collected and analyzed articles on otalgia and described anatomical considerations and clinical evaluation of otalgia, and outlined various causes and treatment options for primary and referred otalgia.
Ear ; Ear Diseases ; Earache ; Facial Pain ; Pathologic Processes

Herniation of the temporomandibular joint (TMJ) into the external auditory canal (EAC) is known to be associated with a defect of the anterior wall of the EAC. Spontaneous herniation of TMJ into EAC is very rare and can induce clicking tinnitus, conductive hearing loss, otalgia, otorrhea and even no symptom. Here we report a very interesting case of spontaneous TMJ herniation, which resulted in severe and annoying clicky tinnitus and otalgia. There was no response to the initial conservative management, so surgical correction of TMJ herniation using titanium mesh was performed. After the surgery, the annoying clicky tinnitus completely disappeared. This study suggests that tinnitus caused by TMJ herniation be considered as another type of surgically curable objective tinnitus.
Ear Canal ; Earache ; Hearing Loss, Conductive ; Temporomandibular Joint* ; Tinnitus* ; Titanium*

There are several causes of otalgia, specifically primary otalgia, which originates inside the ear, and referred otalgia, which originates outside the ear. In a rare case, otalgia may result from myofascial pain syndrome (MPS) due to a contraction of cervical muscles. The author of this study reports a case in which otalgia caused by MPS due to contraction of the trapezius muscle was treated with intramuscular stimulation (IMS). A 48-year-old female patient with otalgia for two weeks was otolaryngologically tested and no anomaly was found. A pain clinic consultation was requested and severe contraction of the trapezius muscle was observed by history taking, visual inspections and palpation. She was successfully returned to the normal state with two sessions of IMS.
Ear ; Earache* ; Female ; Humans ; Middle Aged ; Muscles ; Myofascial Pain Syndromes* ; Pain Clinics ; Palpation ; Superficial Back Muscles*

Herein, we report an unusual case of large tonsillolith presented with acute otalgia. Since the tonsils and tonsillar fossa are supplied by the glossopharyngeal nerve, any irritation or pain can be referred to the ear along the tympanic branch of the glossopharyngeal (Jacobson's) nerve. Also, it is worth re-emphasizing that normal otoscopy must be followed by inspection of the nasal cavities, oral cavity, and oropharynx, with particular note given to the floor of mouth, teeth, tongue, and tonsils because the identification of a causative etiology is necessary to successfully treat referred otalgia.
Ear ; Earache ; Glossopharyngeal Nerve ; Mouth ; Mouth Floor ; Nasal Cavity ; Oropharynx ; Otoscopy ; Palatine Tonsil ; Tongue ; Tooth

Myofascial pain syndrome is defined as the sensory, motor and autonomic symptoms caused by the myofascial trigger points. The sternocleidomastoid muscle is a complex muscle that frequently contains multiple trigger points. These trigger points cause symptoms that are easily misdiagnosed as other conditions. Earache of unexplained origin is likely to be caused by trigger points in the clavicular division of the sternocleidomastiod muscle. The authors report a case of earache caused by a trigger point in the sternocleidomastoid muscle. A 34 year-old woman had earache without any history of trauma or infection. The patient did not have any abnormal finding by otolaryngologic testing, except for an earache, which had not subsided. On physical examination, trigger points in the clavicular division of the sternocleidomastiod muscle were found, and the earache was successfully treated by trigger point injections.
Adult ; Earache* ; Facial Neuralgia ; Female ; Humans ; Myofascial Pain Syndromes ; Pain, Referred ; Physical Examination ; Trigger Points*

BACKGROUND: Because of recent concern about occurrence of otomycosis in otolaryngologic practice, we studied them. OBJECTIVE: The purpose of this study was to investigate clinical and mycological features of otomycosis. METHOD: We evaluated the clinical and mycological aspects of otomycosis in 38 patients from March 1996 to February 1998 in Dongguk University Hospital. RESULTS AND CONCLUSION: Otomycosis showed high incidence in the twenties (23.7%). The ratio of male to female patient was 1:1.5. The seasonal prevalence was highest in autumn. Most common symptoms were otorrhea (39.4%) followed by itching, obstruction sensation, otalgia, and hearing disturbance. The common causative organisms of otomycosis were Aspergillus(A.) niger (36.8%) followed by A. terreus (26.3%), A. flavus (21.1%), A. fumigatus (7.9%), Candida albicans (5.3%), and Mucor sp. (2.6%).
Candida albicans ; Earache ; Female ; Hearing ; Humans ; Incidence ; Male ; Mucor ; Niger ; Otomycosis* ; Prevalence ; Pruritus ; Seasons ; Sensation

PURPOSE: AOM is the most common bacterial URI in children. The bacteriology and antibiotic Tx of AOM in children has been studied in many countries. But, there is few study of causative pathogens and antibiotic Tx of AOM in our country. In this aspect, we performed prospective clinical study to confirm the causative pathogens and assess the clinical responses of cefprozil in AOM patients. METHODS: Thirty three AOM patients enrolled in this study. Tympanocentesis for isolation of causa tive pathogens were performed before Tx of cefprozil. The study patients received cefprozil with dose of 15 mg/kg/bid.po/day for 10-12 days, and initially assessed the clinical response at 4-5 days after receiving cefprozil and finally at the end visit. In vitro susceptibility tests of cefprozil to isolated pathogens were done by disc diffusion method, and in vitro susceptibility tests of cefaclor and cefixime to isolated pathogens were simultaneously performed. RESULTS: Bacterial pathogens[S. pneumoniae(10), H. influenzae(5), S. aureus(2), M. catarrhalis(1) and Group A stretococcus(1)] were isolated from 19 patients. Clinically, all patients had history of abrupt high fever except one. Tympanic perforation was dominant in pathogens isolated cases, and otalgia was significantly developed in non-pathogens isolated cases. The ages of pathogens isolated cases were usually below 2 years. Eighty four point nine percent of the patients including two cases with isolation of intermediate resistant S. pneumoniae were clinically improved. Antimicrobial in vitro activity to S. pneumoniae of cefprozil were superior than that of cefacor and cefixime. CONCLUSION: We confirm that bacteria has the causative role in about 60% cases, and S. pneumoniae is the most common pathogen. Clinically, there were some differences in symptoms, signs and ages between pathogens isolated and non-pathogens isolated cases. The clinical responses of cefprozil in our patients revealed similar outcomes to other countries. And we reconfirm that cefprozil may be clinically effective in cases of AOM due to intermediate resistant S. pneumoniae.
Bacteria ; Bacteriology ; Cefaclor ; Cefixime ; Child ; Diffusion ; Earache ; Fever ; Humans ; Otitis Media* ; Otitis* ; Pneumonia ; Prospective Studies