pain behind the ear
Introduction
Introduction Many patients often have painful manifestations of pain in the posterior mastoid area before facial paralysis occurs. Facial paralysis is a relatively complicated facial disease. The cause of the disease is mostly caused by cold, physical damage or virus invasion. The facial nerve is initially manifested as facial nerve inflammation. At this time, no obvious facial symptoms have formed. Development, the patient will have typical symptoms such as sagging eyes and skewed eyes.
Cause
Cause
The posterior mastoid is a part of the facial nerve. The facial nerve runs in a very narrow facial nerve hole. When the facial nerve is infected by the virus, it becomes edematous and pain occurs after being compressed. Therefore, the pain after the ear after a cold may be a precursor to facial paralysis. Most of the causes are caused by cold, physical damage or viral invasion of the face.
Examine
an examination
Related inspection
Otolaryngology CT examination ear examination
Static check
(1) Stem mastoid: Check whether the stem mastoid is painful or painful on one side of the face and face.
(2) Forehead: Check whether the skin wrinkles in the forehead are the same, light or disappear, and whether the outside of the eyebrows is symmetrical and sagging.
(3) Eye: Check the size of the eye crack, whether the sides are symmetrical, smaller or larger, whether the upper eyelid is drooping, whether the lower eyelid is everted, whether the eyelid is twitching, swelling, whether the conjunctiva is congested or not, whether there is tearing or drying , acid, swelling symptoms.
(4) Ear: Check for tinnitus, ear nausea, and hearing loss.
(5) Cheeks: Check if the nasolabial folds become shallow, disappear or deepen. Whether the cheeks are symmetrical, flat, thickened or twitched. Whether the face feels tight, stiff, numb or atrophy.
(6) mouth: check whether the mouth angle is symmetrical, drooping, lifting or twitching; whether the lips are swollen and whether the person is skewed.
(7) Tongue: Check if the taste is involved.
2. Exercise check
(1) Eyebrow lifting exercise: Check the movement function of the frontal occipital muscle. Severe patient's forehead is flat, wrinkles generally disappear or become significantly shallower, and the outer side of the eyebrows is obviously drooping.
(2) Frowning: Check whether the frowning muscles can move, and whether the amplitude of the eyebrows on both sides is consistent.
(3) Closed eyes: When closing the eyes, you should pay attention to whether the mouth of the affected side has a lifting angle, whether the affected side can be closed, and the degree of closure.
(4) Shrugging the nose: Observe whether there is wrinkles in the nasal pressure muscles, and whether the upper lip movements on both sides are the same.
(5) Show teeth: pay attention to observe the amplitude of the movement of the mouth on both sides, whether the crack is deformed, and the number and height of the upper and lower teeth.
(6) Nuptula: Pay attention to whether the distance between the sides of the mouth and the person is the same, and whether the shape of the mouth is symmetrical.
(7) Drumstick: Mainly check the movement function of the orbicularis oculi muscle.
Diagnosis
Differential diagnosis
First, the outer ear disease
(a) auricle trauma
External force acting on the auricle can cause auricular hematoma or laceration. Auricular hematoma often occurs on the dorsal side of the auricle, with localized slight pain, and severe pain after secondary infection.
(two) auricular cartilage inflammation
Serous cartilage inflammation in the cartilage of the ear cavity or in the cartilage, generally no pain or only slight pain. Suppurative cartilage inflammation, local redness and swelling, and severe pain.
(three) ear herpes zoster
The ear banded sore rash, also known as Bamsay Hunt syndrome, is a viral infection of the facial nerve ganglia, with severe earache onset. According to the condition, it can be divided into three types.
1. Herpes simplex type: First, there is ear discomfort or burning sensation, followed by ear pain, redness and swelling of the auricle and external auditory canal. After 3-5 days, local skin develops herpes. Herpes mainly occurs in the concave auricle, occasionally in the external auditory canal, and scars after a few days, and heales after about a week.
2. Herpes is complicated by facial nerve damage: in addition to sore rash, there is also ipsilateral facial paralysis. Facial paralysis usually occurs about a week after the appearance of cancer rash.
3. Herpes is complicated by facial nerve and auditory nerve damage type: except for the lesions involving the geniculate ganglia, the injured auditory nerve has tinnitus, sensorineural deafness and dizziness. This type is more serious, suggesting that the lesion is located in the labyrinth of the facial nerve.
Tongue pharyngeal herpes or vagal ganglion herpes can be accompanied by earache, but no facial paralysis. Glossopharyngeal herpes has no ear lesions, and herpes appears in soft palate and tonsils. When suffering from vagal ganglion neuropathy, herpes is located in the posterior sulcus and the posterior wall of the external auditory canal. The first and second cervical nerve sores can also cause earache, which is severely painful and limited to the mastoid. Herpes is located on the convex surface of the auricle and the skin of the neck.
(4) External auditory canal, embolism or foreign body
It can compress the skin of the ear canal or the tympanic membrane, especially after water swelling.
(5) Deafness
Deafness is an acute suppurative inflammation of the outer ear canal skin hair follicle or sebaceous gland, which is prone to occur in the cartilage of the ear canal. Local redness and tenderness. Spontaneous severe pain, especially at night or when chewing.
(6) Acute diffuse otitis externa
Acute diffuse otitis externa is a widespread suppurative infection of the external auditory canal. There are obvious spontaneous pain and auricular pull pain or tragus tenderness.
(7) Necrotic otitis externa
Also known as malignant otitis externa. This disease often occurs in diabetic patients, so there is also called diabetic otitis externa. The pathogenic bacteria are Pseudomonas aeruginosa. The ear canal necrosis spreads rapidly to the surrounding area, which can be complicated by mastoiditis, skull base osteomyelitis, meningitis, and sepsis.
Second, middle ear disease
(1) Tympanic membrane trauma
The most common cause of tympanic membrane trauma is a sudden increase in pressure in the external auditory canal, such as knocking, slap diving, and so on. In addition, the tympanic membrane can be damaged because the eustachian tube is excessively blown and the instrument is too deep when taking foreign objects. Temporary tearing pain and rupture of the tympanic membrane, dizziness, tinnitus.
(B) bullous tympanitis
Sudden tingling occurred suddenly after feeling. Check for visible bloody blisters in the external auditory canal and tympanic membrane, and self-healing in a few days.
(C) acute suppurative otitis media
Ear pain is one of the main symptoms of acute suppurative otitis media, often a complication of upper respiratory tract infection. Sudden onset, severe people have unbearable stinging and jumping pain. After the secretion of the middle ear of the tympanic membrane is discharged, the pain is alleviated. Because this disease is often accompanied by an inflammatory reaction of the mastoid periosteum, it often has tenderness and tenderness in the mastoid area. If the pain in the middle ear is still not relieved, the possibility of acute mastoiditis should be considered.
(D) acute episodes of chronic suppurative otitis media
Chronic bone ulcer or cholesteatoma otitis media, such as pus drainage, acute ear attacks, headache, fever, it is suggested that intracranial and extracranial complications will occur.
(5) Pneumatic traumatic otitis media
In the case of a sudden change in air pressure such as rapid lifting or diving at high altitude, air pressure traumatic otitis media with ear pain, tinnitus and hearing loss may occur.
(6) Middle ear cancer
On the basis of chronic suppurative otitis media, initially only pain, late persistent dull pain, bloody secretions in the ear canal and granulation prominent, brittle and easy to hemorrhage, biopsy can confirm the diagnosis.
(7) Bell's face
It is an unidentified peripheral facial paralysis. A few hours before the facial paralysis occurs, the deep dull pain in the area behind the ear occurs first, followed by facial paralysis. The pain usually lasts for a few days.
