Asked By: Jason Lee Date: created: Jul 28 2023

Why does my ear and head hurt on the same side

Answered By: Xavier Jenkins Date: created: Jul 31 2023

Ear problems – A dull, aching pressure on the side of the head, face, or jaw may indicate an ear infection or a vestibular migraine, Symptoms that usually accompany ear-related problems include:

    pain in the ear, jaw, or templedizziness or vertigo trouble hearing tinnitus, or a ringing in the earsvision problemsfluid discharge from the ear

What infection causes pain behind ear base of skull?

Mastoiditis is an infection of the mastoid bone of the skull. The mastoid bone is located just behind the ear. Mastoiditis is an infection of the bony air cells in the mastoid bone, located just behind the ear. It is rarely seen today because of the use of antibiotics to treat ear infections. This child has drainage from the ear and redness (erythema) behind the ear over the mastoid bone. Mastoiditis is an infection of the bony air cells in the mastoid bone, located just behind the ear. It is rarely seen today because of the use of antibiotics to treat ear infections. This child has noticeable swelling and redness behind his right ear because of mastoiditis. Mastoid air cells are open, air-containing spaces in one of the skull bones.

Asked By: Reginald Campbell Date: created: Feb 04 2023

Can ear infection spread to skull

Answered By: Justin Rivera Date: created: Feb 05 2023

Malignant otitis externa is a disorder that involves infection and damage of the bones of the ear canal and at the base of the skull. Malignant otitis externa is caused by the spread of an outer ear infection (otitis externa), also called swimmer’s ear. It is not common. Risks for this condition include:

Chemotherapy Diabetes Weakened immune system

External otitis is often caused by bacteria that are hard to treat, such as pseudomonas. The infection spreads from the floor of the ear canal to the nearby tissues and into the bones at the base of the skull. The infection and swelling may damage or destroy the bones. The infection may affect the cranial nerves, brain, or other parts of the body if it continues to spread. Symptoms include:

Ongoing drainage from the ear that is yellow or green and smells bad. Ear pain deep inside the ear. Pain may get worse when you move your head. Hearing loss, Itching of the ear or ear canal.Fever.Trouble swallowing.Weakness in the muscles of the face.

Your health care provider will look into your ear for signs of an outer ear infection. The head around and behind the ear may be tender to touch. A nervous system (neurological) exam may show that the cranial nerves are affected. If there is any drainage, the provider may send a sample of it to the lab.

CT scan of the head MRI scan of the head Radionuclide scan

The goal of treatment is to cure the infection. Treatment often lasts for several months, because it is difficult to treat the bacteria and reach an infection in bone tissue. You will need to take antibiotic medicines for a long period of time. The medicines may be given through a vein (intravenously), or by mouth.

  1. Antibiotics should be continued until scans or other tests show the inflammation has gone down.
  2. Dead or infected tissue may need to be removed from the ear canal.
  3. In some cases, surgery may be needed to remove dead or damaged tissue in the skull.
  4. Malignant otitis externa most often responds to long-term treatment, especially if treated early.

It may return in the future. Severe cases may be deadly. Complications may include:

Damage to the cranial nerves, skull, or brainReturn of infection, even after treatmentSpread of infection to the brain or other parts of the body

Contact your provider if:

You develop symptoms of malignant otitis externa.Symptoms continue despite treatment.You develop new symptoms.

Go to the emergency room or call the local emergency number (such as 911) if you have:

Convulsions Decreased consciousness Severe confusion Facial weakness, loss of voice, or difficulty swallowing associated with ear pain or drainage

To prevent an external ear infection:

Dry the ear thoroughly after it gets wet. Avoid swimming in polluted water. Protect the ear canal with cotton or lamb’s wool while applying hair spray or hair dye (if you are prone to getting external ear infections). After swimming, place 1 or 2 drops of a mixture of 50% alcohol and 50% vinegar in each ear to help dry the ear and prevent infection. Maintain good glucose control if you have diabetes.

Treat acute otitis externa completely. Do not stop treatment sooner than your provider recommends. Following your provider’s plan and finishing treatment will lower your risk of malignant otitis externa. Osteomyelitis of the skull; Otitis externa – malignant; Skull-base osteomyelitis; Necrotizing external otitis Araos R, D’Agata E.

Pseudomonas aeruginosa and other pseudomonas species. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases,9th ed. Philadelphia, PA: Elsevier; 2020:chap 219. Matlock AG, Pfaff JA. Otolaryngology. In: Walls RM, Hockberger RS, Gausche-Hill M, eds.

Rosen’s Emergency Medicine: Concepts and Clinical Practice,10th ed. Philadelphia, PA: Elsevier; 2023:chap 58. Updated by: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M.

Asked By: Charles Harris Date: created: Mar 14 2023

Why does the back of my head hurt

Answered By: Lawrence Torres Date: created: Mar 14 2023

Tension headaches –

Tension headaches are the most common cause of pain in the back of the head. They can last for 30 minutes to 7 days. Severe stress, fatigue, lack of sleep, skipping meals, poor body posture, or not drinking enough water may cause these types of headaches. Patients usually feel tightening around the back or front of the head; pain may range from dull to severe. Treatment includes painkillers, lifestyle modifications, massage, and sometimes relaxing techniques (e.g., meditation). However, frequent tension headaches need a doctor’s supervision for further treatment.

Asked By: Adam Young Date: created: Dec 18 2022

Why does my neck ear and head hurt on one side

Answered By: Angel Perez Date: created: Dec 21 2022

Occipital neuralgia is a distinct type of headache characterized by piercing, throbbing, or electric-shock-like chronic pain in the upper neck, back of the head, and behind the ears, usually on one side of the head. Typically, the pain of occipital neuralgia begins in the neck and then spreads upwards.

Some individuals will also experience pain in the scalp, forehead, and behind the eyes. Their scalp may also be tender to the touch, and their eyes especially sensitive to light. The location of pain is related to the areas supplied by the greater and lesser occipital nerves, which run from the area where the spinal column meets the neck, up to the scalp at the back of the head.

The pain is caused by irritation or injury to the nerves, which can be the result of trauma to the back of the head, pinching of the nerves by overly tight neck muscles, compression of the nerve as it leaves the spine due to osteoarthritis, or tumors or other types of lesions in the neck.

Asked By: Jonathan Miller Date: created: Apr 04 2023

Can an ear infection make your whole head hurt

Answered By: Adam Johnson Date: created: Apr 07 2023

As one of the multiple symptoms of an ear infection, headaches can indicate a need for further examination. Other symptoms accompanied by a headache help medical professionals to diagnose and treat ear infections in children. Headaches are not typical symptoms of ear infections in adults.

When should I be concerned about back of head pain?

See your provider soon if: Your headaches wake you up from sleep, or your headaches make it difficult for you to fall asleep. A headache lasts more than a few days. Headaches are worse in the morning.

Why do I have a painful lump behind my ear at the base of my skull?

Common Infections Can Cause Lumps Behind Your Ear – Lumps behind the ear can often be caused by colds, the flu, strep throat or respiratory infections. That’s because an infection can cause the lymph nodes behind your ears to become swollen and inflamed. Most of the time, swollen glands are not a cause for concern.

They will likely go away on their own or if caused by a bacterial infection, be treated easily with antibiotics. Your doctor may also recommend over-the-counter pain medication for any discomfort. You can find these easily at Smith’s Drug Store or another local pharmacy. If the infection is more serious it may cause the lymph nodes to become really enlarged, swollen, red and tender.

One serious infection that can cause a lump behind the ear is mastoiditis, Mastoiditis is a bacterial infection that affects the mastoid bone behind the ear. It often occurs when an i nfection in the middle ear is left untreated and spreads. While it’s most often seen in young children, mastoiditis can occur at any age.

Severe pain behind the earEar drainageFeverHeadache

If left untreated, mastoiditis can lead to hearing loss, meningitis, blood clots and facial nerve paralysis. If you have any symptoms of mastoiditis, it’s important to seek medical attention right away.

Asked By: Gabriel Campbell Date: created: Jun 04 2022

Is occipital neuralgia life threatening

Answered By: Jeremiah Carter Date: created: Jun 05 2022

Even though occipital neuralgia is not a life-threatening condition, it can have a serious impact on your overall quality of life. It can cause pain that interferes with daily activities and may prevent you from enjoying time with family or friends. You can often find relief from the pain caused by occipital neuralgia through various treatments.

Asked By: Chase Evans Date: created: Mar 11 2023

What are the red flags for ear infection

Answered By: Bryan Ward Date: created: Mar 11 2023

A Retrospective Estimate of Ear Disease Detection Using the “Red Flags” in a Clinical Sample 1 Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA Find articles by 2 Division of Audiology, Mayo Clinic, Scottsdale, AZ, USA 3 Department of Audiology, Norton Sound Health Corporation, Nome, AK, USA Find articles by 4 Department of Otorhinolaryngology, Mayo Clinic, Jacksonville, FL, USA Find articles by 6 Department of Medical Social Science, Northwestern University, Chicago, IL, USA Find articles by 7 Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, USA Find articles by 4 Department of Otorhinolaryngology, Mayo Clinic, Jacksonville, FL, USA Find articles by 1 Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA 8 The Hugh Knowles Center, Northwestern University, Evanston, IL, USA Find articles by 4 Department of Otorhinolaryngology, Mayo Clinic, Jacksonville, FL, USA Find articles by

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1 Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA 2 Division of Audiology, Mayo Clinic, Scottsdale, AZ, USA 3 Department of Audiology, Norton Sound Health Corporation, Nome, AK, USA 4 Department of Otorhinolaryngology, Mayo Clinic, Jacksonville, FL, USA 5 Don Nielsen Consulting, LLC, Dublin, OH, USA 6 Department of Medical Social Science, Northwestern University, Chicago, IL, USA 7 Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, USA 8 The Hugh Knowles Center, Northwestern University, Evanston, IL, USA

Corresponding author: Niall Klyn, Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, 2240 Campus Dr, Evanston, IL 60208, USA. The purpose of this study was to evaluate the specificity and sensitivity of two red flag protocols in detecting ear diseases associated with changes in hearing.

  • The presence of red flag symptoms was determined in a chart review of 307 adult patients from the Mayo Clinic Florida departments of Otorhinolaryngology and Audiology.
  • Participants formed a convenience sample recruited for a separate study.
  • Neurotologist diagnosis was the criterion for comparisons.
  • Of the 251 patient files retained for analysis, 191 had one or more targeted diseases and 60 had age- or noise-related hearing loss.

Food and Drug Administration (FDA) red flags sensitivity was 91% (CI 86–95%) and specificity was 72% (CI 59–83%). American Academy of Otolaryngology (AAO-HNS) red flags sensitivity was 98% (CI 95–99%) and specificity was 20% (CI 11–32%). Stakeholders must determine which diseases are meaningful contraindications for hearing aid use, and whether these red-flag protocols have acceptable levels of sensitivity and specificity.

  • As direct-to-consumer models of hearing devices increase, a disease detection method that does not require provider intercession would be useful.
  • The FDA recently announced they would no longer enforce the mandatory medical evaluation or waiver protocols for individuals seeking hearing aids ().
  • This policy change leaves a gap in regulatory guidance for audiologists and hearing aid dispensers.

Medical evaluation is potentially important because changes in an individual’s hearing could be a symptom of a disease associated with risks to an individual’s life or health (). Failing to detect such diseases can have significant ramifications for the individual and the healthcare system.

  1. For many diseases with symptomatic changes in hearing, timely treatment can lead to improved patient outcomes and a reduced burden on the healthcare system.
  2. The potential seriousness of undetected diseases was part of the stated rationale of the earlier FDA surveillance scheme.
  3. As part of that scheme, the FDA set forth seven “red flags” that each warrant a full medical evaluation prior to procurement and use of hearing aids ().

In addition, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) proposed its own set of red flags to provide guidance on when a patient should be evaluated by a physician (). With the recent change in FDA policy, the onus is entirely on audiologists and hearing aid dispensers to dutifully screen and appropriately triage individuals suspected of having insidious ear disease.

  1. The FDA and AAO-HNS red flag criteria, therefore, may continue to serve as important tools ensuring consumer safety in hearing healthcare.
  2. Though the current iteration of the FDA red flags has been in use for over 20 years, we could not find published, peer-reviewed estimates of their effectiveness in screening for diseases related to changes in hearing.

This brief report evaluates the FDA and AAO-HNS red flags in a sample of patients with disease-related etiologies and those with age- or noise-related changes in hearing as determined by a board-certified neurotologist (). This sample allowed for estimation of the sensitivity and specificity of the screening tools.

The stated purpose of both sets of red flags is to suggest medical evaluation when warranted (, ). This brief report will focus on the red flags’ sensitivity and specificity in detecting disease, and does not comment on whether a hearing aid would be an appropriate option for the study sample. As far as is possible with the large set of diseases and conditions considered by the red flags, this report follows the STARD protocol in reporting its results () Patients ( n = 307, 48% female) were recruited from the Otorhinolaryngology and Audiology Departments of the Mayo Clinic Florida between June, 2014 and August, 2015 as part of development of the Consumer Ear Disease Risk Assessment (CEDRA, ) questionnaire.

Participants were between 40–80 years of age (mean = 62.9, SD = 9.8), and were seeking care for ear- or hearing-related complaints. This convenience sample was chosen to have a high percentage of targeted disease-related diagnoses, and was limited to 25% of the patients having age- or noise-related changes in hearing.

  1. An a priori power analysis indicated an initial sample size of 300 was sufficient for the Kleindienst et al.
  2. Study, with 80% power to detect an area under the curve of 0.63 or greater with alpha =,05.
  3. No separate power analysis was performed for the current analysis.
  4. Participants received treatment according to the standard-of-care at Mayo Clinic, and the study was approved by the Mayo Clinic IRB.

As part of the standard-of-care at Mayo Clinic, audiology examination, case history, and background data were entered into the electronic health record (EHR), which were later extracted for this study’s analysis. All study participants received an examination by a board-certified neurotologist () whose findings were used to determine the presence/absence of any of 104 diseases that may include otologic symptoms (see, for a complete list; ).

  • All examinations were performed according to the practice standards used by Mayo Clinic during the study.
  • The FDA and AAO-HNS red flags were extracted from the audiometric data, background notes, and case history, all of which were accessible to the neurotologist.
  • Only examination information collected equal-to or less than 90 days before or after the neurotologic exam was included in the analysis because these diseases have varying time courses.

This resulted in 251 patients for the present analysis. Two independent coders (NK and DZ) analyzed the de-identified dataset to determine the presence or absence of the red flag symptoms. Both coders had access to the neurotologist diagnosis, but completed their analysis without reference to it.

  1. Initial agreement between the two coders was 91%.
  2. Examination of the discordant classifications showed that disagreements resulted from different interpretations of the red flags.
  3. The study team discussed possible interpretations and decided on a single uniform interpretation for this study.
  4. The red flags and the study team’s operationalization of each may be found in,

The results here reflect complete final agreement between the two coders. Operationalization of the Red Flags for the Current Study

FDA Red Flags Key criteria used in chart review
Visible congenital or traumatic deformity of the ear. Search for “deformity,” or “malformation,” of the “pinna”, or “external ear”.
History of active drainage from the ear within the previous 90 days. Search for “drain,” “pus,” or “otorrhea.”
History of sudden or rapidly progressive hearing loss within the previous 90 days. Search for “sudden,” “rapid,” “acute,” and “hearing loss” within 90 days.
Acute or chronic dizziness. Search for “dizziness,” or “vertigo.”
Unilateral hearing loss of sudden or recent onset within the previous 90 days. Search for “unilateral” or “asymmetric” within 90 days.
Audiometric air-bone gap equal to or greater than 15 dB at 500 Hz, 1000 Hz, and 2000 Hz. * Calculate air-bone gap at 500 Hz, 1000 Hz, and 2000 Hz, then calculate the average.
Visible evidence of significant cerumen accumulation or a foreign body in the ear canal. Search for “blockage,” “foreign,” “debris,” “object,” “cerumen obstructing clear view of the tympanic membrane,” or “wax obstructing clear view of the tympanic membrane”, “impaction”
Pain or discomfort in the ear. * Search for “pain,” “discomfort,” “fullness,” “pressure,” or “otalgia.”
AAO-HNS Red Flags
Hearing loss with a positive history of ear infections, noise exposure, familial hearing loss, TB, syphilis, HIV, Meniere’s disease, autoimmune disorder, ototoxic medication use, otosclerosis, von Recklinghausen’s neurofibromatosis, Paget’s disease of bone, ear or head trauma related to onset. Hearing loss as PTA,5, 1, 2 kHz > 20 dB HL, and search for “noise,” “familial/family,” “TB/tuberculosis,” “syphilis,” “HIV/AIDS,” “Meniere’s,” “autoimmune,” “ototoxic,” “otosclerosis,” “Recklinghausen,” “neurofibromatosis,” “Paget,” or “trauma”
History of pain, active drainage, or bleeding from an ear. * Search for “pain,” “discomfort,” “pressure,” “fullness,” “otalgia,” “drain/drainage,” “blood,” “bleeding,” “pus,” or “otorrhea.”
Sudden onset or rapidly progressive hearing loss. Search for “sudden,” “rapid,” or “acute.”
Acute, chronic, or recurrent episodes of dizziness. Search for “dizziness” or “vertigo.”
Evidence of congenital or traumatic deformity of the ear. Search for “deformity,” or “malformation,” of the “pinna”, or “external ear”.
Visualization of blood, pus, cerumen plug, foreign body, or other material in the ear canal. Search for “blood,” “bleeding,” “pus,” “blockage,” “foreign,” “debris,” “object,” “cerumen,” or “wax.”
An unexplained conductive hearing loss or abnormal tympanogram. Tympanograms with pressure < −100 daPa, or classified as type "B" or "C."
Unilateral or asymmetric hearing loss (a difference of greater than 15 dB Pure Tone Average between ears); or bilateral hearing loss > 30 dB. * Calculated PTA,5,1,2 kHz for each ear and subtracted. For bilateral, flagged if both ears’ PTA > 30 dB HL.
Unilateral or pulsatile tinnitus. Search for “tinnitus” with “pulsatile” or “unilateral.”
Unilateral or asymmetrically poor speech discrimination scores (a difference of greater than 15% between ears); or bilateral speech discrimination scores <80%. Examine scores from NU-6 for each ear and subtract. For bilateral, flagged if both ears’ speech scores were < 80%.

For each of the FDA and AAO-HNS red flag sets, a patient was coded as a “refer” in the presence of any red flag sign or symptom, and as a “pass” only when no red flags were present. Sensitivity was calculated as the number of correctly identified diseased cases divided by the total number of diseased cases.

Specificity was calculated as the number of correctly identified non-diseased cases divided by the total number of non-diseased cases. The sensitivity and specificity of the screening tools are reported using the neurotologist’s diagnosis as the criterion, with the exact binomial 95% confidence intervals in parentheses.

The sensitivity and specificity for the FDA red flags was 91% (CI 86–95%) and 72% (CI 59–83%), respectively. The sensitivity and specificity for the AAO-HNS red flags was 98% (CI 95–99%) and 20% (CI 11–32%), respectively. See for cross tables. We could not find peer-reviewed estimates of the cumulative prevalence of these diseases, so the positive predictive value (PPV) and negative predictive value (NPV) were estimated using three prevalence levels: 0.5%, 2%, and 5%.

FDA Diseased Age- or noise-related loss Totals AAO-HNS Diseased Age- or noise-related loss Totals
Flagged 174 17 191 Flagged 187 48 235
Passed 17 43 60 Passed 4 12 16
Totals 191 60 251 Totals 191 60 251

Estimated Positive Predictive Value (PPV) and Negative Predictive Value (NPV) at Three Prevalence Levels

0.5% prevalence 2% prevalence 5% prevalence
PPV NPV PPV NPV PPV NPV
FDA 1.6% 99.9% 6.2% 99.7% 14.6% 99.3%
AAO-HNS 0.6% 99.9% 2.4% 99.8% 6.1% 99.5%

The data presented here provide the first published estimates of the sensitivity and specificity of the FDA and AAO-HNS red flags in screening for any of the 104 ear diseases described in, Sensitivity and specificity are characteristics of the tests themselves, and do not vary with the prevalence of the disease. The PPV and NPV estimates provide some context for these characteristics by factoring in how rare or common the diseases are in the general population, and are provided for illustrative purposes only, as the true cumulative prevalence of ear diseases is unknown. These results highlight the relatively low PPV of these tests: for the AAO-HNS red flags in the highest prevalence case, only 6% of individuals referred for further diagnosis have a disease. For the FDA red flags in the highest prevalence case, that number rose to 14.6%. Conversely, under reasonable prevalence estimates, passing either set of red flags indicated that the individual likely has no disease, with >99% passing the test being disease-free. The present study highlights two potential concerns in implementing the red flags. First, an individual seeking a hearing aid must see a provider (e.g. audiologist or hearing instrument specialist) to obtain the required audiometric data included in both the FDA and AAO-HNS red flags. Though this step potentially avoids individuals unnecessarily seeing a physician for non-medically treatable conditions, it still requires the outlay of time and money for the provider assessment. With increasing direct-to-consumer sales of hearing devices, a disease detection method with acceptable levels of sensitivity and specificity that does not require provider participation could be more efficient. developed a consumer questionnaire that requires no examination and possesses test characteristics comparable to the FDA red flags, and with better specificity than the AAO-HNS red flags. The second potential concern in using the red flags is that some items in both the FDA and AAO-HNS red flag descriptions are ambiguously defined. For example, does the FDA red flag “audiometric air – bone gap equal to or greater than 15 decibels at 500, 1,000, and 2,000 Hz” apply to gaps at all three frequencies, any frequency, or an average of the three? In the initial coding, one author coded a patient reporting “pressure” or “fullness” as a flag for both the FDA and AAO-HNS, and the other author did not. For this project the final coding was determined by consensus among the research team, but the ambiguous definitions leave open the possibility of variance in how these red flags are used. Indeed, in preliminary analyses (not shown), these different interpretations were found to change the sensitivity and specificity of the red flags. This could cause individuals to not be referred when they have a disease or non-diseased individuals to pursue unnecessary care, simply depending on the dispenser’s or audiologist’s interpretation of the red flags. This study has limitations. First, we studied a clinical sample ( n = 251), that does not represent the population prevalence of ear disease. The high prevalence of disease, however, provided a more rigorous test of the red flag’s sensitivity than would have been possible in a random sample of the hearing aid seeking population. The concern is therefore that the diseased and control individuals in this study may be systematically different than the general population. An ongoing research project is evaluating the red flag criteria and CEDRA in a larger, more representative population of individuals seeking hearing healthcare. A second limitation is that the red flag symptoms were derived from a retrospective analysis of case history and examination data. The symptoms noted by the clinicians therefore had to be interpreted to determine if they matched any red flag. The high agreement between coders indicates that the possibility of the interpretative process skewing the results is small, but that different interpretations of the red flags themselves affect the outcomes. The ongoing research project discussed above is explicitly examining the red flag criteria as interpreted by practicing audiologists. The 104 diseases targeted here have not been independently evaluated as meaningful contraindications of hearing device acquisition and use. The ratings provided by neurotologists in covered a range of severity should the disease go undetected. Here, however, the red flags were tested for their effectiveness at determining the presence or absence of a disease, not the potential consequence of missed detection. Whether an otolaryngologist would clear a patient for hearing aid use, regardless of the presence of a disease or condition other than presbycusis, is part of the ongoing research described above. Finally, the authors note that neurotologist diagnosis is not a strictly defined reference test as set forth in the STARD protocol (). Board certification in neurotology represents the highest medical subspecialty credential for assessing ear disease, and provides the best available standardization for any effort to replicate these results. For any screening effort, the relative costs and benefits of the procedure must be weighed. Whether screening for these diseases is appropriate and necessary, and the acceptable sensitivity and specificity for a screener, are questions that must be considered by the public and policymakers. The results presented here can help inform such decision-making. Supplemental Digital Content 1. Text that provides all targeted ear diseases. pdf (15K, pdf) All authors contributed equally to this work.N.K. and D.Z. provided analyses.S.K. reviewed analyses and provided critical interpretation.D.Z., L.L., and S.K. contributed to data collection.S.K., R.A. and D.Z. pulled and de-identified data for analysis.N.K. wrote the initial draft of this work. All authors reviewed, edited, and approved the final paper.

21 C.F.R.801.421 (2016). American Academy of Otolaryngology-Head and Neck Surgery. ; Position Statement: Red Flags Warning of Ear Disease.2014, American Board of Otolarynology. Neurotology Subcertification Exam.2017 Retrieved from, Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig L, Kressel HY. STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. Radiology.2015; 277 (3):826–832. Committee on Accessible and Affordable Hearing Health Care for Adults; Board on Health Sciences Policy; Health and Medicine Division; National Academies of Sciences, Engineering, and Medicine. Hearing Health Care for Adults: Priorities for Improving Access and Affordability. Washington, DC: National Academies Press; 2016. Food and Drug Administration, Center for Devices and Radiological Health. Immediately in Effect Guidance Document: Conditions for Sale for Air- Conduction Hearing Aids. ; Guidance for Industry and Food and Drug Administration Staff.2016, Kleindienst SJ, Dhar S, Nielsen DW, et al. Identifying and Prioritizing Diseases Important for Detection in Adult Hearing Health Care. American Journal of Audiology.2016; 25 (3):224. doi: 10.1044/2016_AJA-15-0079. Kleindienst SJ, Zapala DA, Nielsen DW, et al. Development and initial validation of a consumer questionnaire to predict the presence of ear disease. JAMA Otolaryngol Head Neck Surg 2017

: A Retrospective Estimate of Ear Disease Detection Using the “Red Flags” in a Clinical Sample

What causes pain behind the ear down the neck?

Occipital Neuralgia is a condition in which the occipital nerves, the nerves that run through the scalp, are injured or inflamed. This causes headaches that feel like severe piercing, throbbing or shock-like pain in the upper neck, back of the head or behind the ears.

Osteoarthritis of the upper cervical spine Trauma to the greater and/or lesser occipital nerves Compression of the greater and/or lesser occipital nerves or C2 and/or C3 nerve roots from degenerative cervical spine changes Cervical disc disease Tumors affecting the C2 and C3 nerve roots Gout Diabetes Blood vessel inflammation Infection

Symptoms of occipital neuralgia include continuous aching, burning and throbbing, with intermittent shocking or shooting pain that generally starts at the base of the head and goes to the scalp on one or both sides of the head. Patients often have pain behind the eye of the affected side of the head.

Additionally, a movement as light as brushing hair may trigger pain. The pain is often described as migraine-like and some patients may also experience symptoms common to migraines and cluster headaches, Occipital neuralgia can be very difficult to diagnose because of its similarities with migraines and other headache disorders.

Therefore, it is important to seek medical care when you begin feeling unusual, sharp pain in the neck or scalp and the pain is not accompanied by nausea or light sensitivity. Begin by addressing the problem with your primary care physician. They may refer you to a specialist.

Diagnosis of occipital neuralgia is tricky, because there is not one concrete test that will reveal a positive or negative diagnosis. Typically, a physical examination and neurological exam will be done to look for abnormalities. If the physical and neurological exams are inconclusive, a doctor may order further imaging to rule out any other possible causes of the pain.

A magnetic resonance imaging (MRI) test may be ordered, which can show three-dimensional images of certain body structures and can reveal any impingement, A computed tomography scan (CT or CAT scan) will show the shape and size of body structures. Some doctors may use occipital nerve blocks to confirm their diagnosis.

Heat: patients often feel relief when heating pads or devices are placed in the location of the pain. Such heating pads can be bought over-the-counter or online. Physical therapy or massage therapy. Oral Medication:

Anti-inflammatory medications ; Muscle relaxants ; and Anticonvulsant medications.

Percutaneous nerve blocks: these injections can be used both to diagnose and treat occipital neuralgia. Botulinum Toxin (Botox) Injections : Botox injections can be used to decrease inflammation of the nerve

Occipital Nerve Stimulation : This surgical treatment involves the placement of electrodes under the skin near the occipital nerves. The procedure works the same way as spinal cord stimulation and uses the same device. The procedure is minimally invasive and surrounding nerves and structures are not damaged by the stimulation. It is an off-label indication for an FDA-approved device.

Spinal Cord Stimulation : this surgical treatment involves the placement of stimulating electrodes between the spinal cord and the vertebrae. The device produces electrical impulses to block pain messages from the spinal cord to the brain. C2,3 Ganglionectomy- This treatment involves the disruption of the second and third cervical sensory dorsal root ganglion, Acar et al (2008) studied the short-term and long-term effects of this procedure. The study found that 95% of patients had immediate relief with 60% maintaining relief past one year.

Patients are encouraged to regularly follow up with their primary care providers and specialists to maintain their treatment. Surgeons like patients to return to the clinic every few months in the year following the surgery. In these visits, they may adjust the stimulation settings and assess the patient’s recovery from surgery.

Evaluation of Occipital Nerve Stimulation in Intractable Occipital Neuralgias Ultrasound Guided Platelet Rich Plasma Injections for Post Traumatic Greater Occipital Neuraliga A Comparison of Dexamethasone and Triamcinolone for Ultrasound-guided Occipital C2 Nerve Blocks A Prospective Controlled Treatment Trial for Post-Traumatic Headaches

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Sweet, J.A., Mitchell, L.S., Narouze, S., Sharan, A.D., Falowski, S.M., Schwalb, J.M., Pilitsis, J.G. (2015). Occipital Nerve Stimulation for the Treatment of Patients With Medically Refractory Occipital Neuralgia. Neurosurgery, 77 (3), 332–341. doi: 10.1227/neu.0000000000000872J This systematic review compiles treatment recommendations for the use of occipital nerve stimulation to treat occipital neuralgia. The review found various articles supporting these recommendaitons. Janjua, M.B., Reddy, S., Ahmadieh, T.Y.E., Ban, V.S., Ozturk, A.K., Hwang, S.W., Arlet, V. (2020). Occipital neuralgia: A neurosurgical perspective. Journal of Clinical Neuroscience, 71, 263–270. doi: 10.1016/j.jocn.2019.08.102 This paper investigates the different causes of occipital neuralgia and surgical interventions that have aided in relieving pain. The paper also provides case examples for each cause and corresponding treatment. The paper found that the C2 nerve is the most common site for compression causing the pain. Treatments such as C2 neurectomy and/or ganglionectomy offer the most pain relief for patients. Texakalidis, P., Tora, M.S., Nagarajan, P., Jr, O.P.K., & Boulis, N. (2019). High cervical spinal cord stimulation for occipital neuralgia: a case series and literature review. Journal of Pain Research, Volume 12, 2547–2553. doi: 10.2147/jpr.s214314P This study uses a literature review to support the author’s personal experiences treating occipital neuralgia with spinal cord sitmulation to show the efficacy of the treatment for this condition. The study found that high cervical spinal cord stimulation results in 40-50% success in patients with occipital neuralgia and thus, spinal cord stimulation may be considered as a treatment option.

Amy’s Occipital Neuralgia Story Michael’s Story

Patient Pages are authored by neurosurgical professionals, with the goal of providing useful information to the public. Julie G Pilitsis, MD, PhD, FAANS Chair, Neuroscience & Experimental Therapeutics Professor, Neurosurgery and Neuroscience & Experimental Therapeutics Albany Medical College Dr.

Pilitsis specializes in neuromodulation with research interests in treatments for movement disorders and chronic pain. Olga Khazen, BS Research Coordinator Neuroscience & Experimental Therapeutics Albany Medical College The AANS does not endorse any treatments, procedures, products or physicians referenced in these patient fact sheets.

This information provided is an educational service and is not intended to serve as medical advice. Anyone seeking specific neurosurgical advice or assistance should consult his or her neurosurgeon, or locate one in your area through the AANS’ Find a Board-certified Neurosurgeon online tool.

Where does head hurt with ear infection?

An ear, throat, or nose infection can also trigger a headache. This is because hollow sinus cavities connect the ear, throat, and nose in the middle of the forehead, cheekbones, noses, and eyes.

Asked By: David Coleman Date: created: May 04 2023

Why does the back of my head hurt

Answered By: Michael Russell Date: created: May 04 2023

Tension headaches –

Tension headaches are the most common cause of pain in the back of the head. They can last for 30 minutes to 7 days. Severe stress, fatigue, lack of sleep, skipping meals, poor body posture, or not drinking enough water may cause these types of headaches. Patients usually feel tightening around the back or front of the head; pain may range from dull to severe. Treatment includes painkillers, lifestyle modifications, massage, and sometimes relaxing techniques (e.g., meditation). However, frequent tension headaches need a doctor’s supervision for further treatment.

How does an ear infection make your head feel?

The vestibular system works in a similar way to a stereo, with your left and right ears sending separate signals to your brain. If one ear becomes infected, these signals become out of sync, which confuses your brain and triggers symptoms such as dizziness and loss of balance.

Asked By: Cyrus Thomas Date: created: Nov 16 2022

Why do I get a headache in the back of my head

Answered By: Adrian James Date: created: Nov 18 2022

Why Does the Back of My Head Hurt? Medically Reviewed by Jennifer Robinson, MD on December 13, 2022 If you have pain in the back of your head, you’d probably enjoy some relief. To find a long-lasting fix, you need to find the root of the problem. From poor posture to different types of headaches, the back of your head may hurt due to one of the following causes.

Tension headache. This is the most common type of headache. It happens when the muscles in your scalp and neck tighten. This causes pain on the sides and back of your head. Usually it’s a dull pain that doesn’t throb. Poor posture. If you tend to slouch when you sit or stand, that can strain the muscles in the back of your head, upper back, neck, and jaw.

It also can put pressure on the nerves in those areas. As a result, poor posture can cause tension headaches and pain in the back of your head. Standing or sitting up straight can help relieve headaches from poor posture. Over-the-counter pain relievers may help as well.

In some cases, you may need physical therapy. Arthritis headache. The main symptom of an arthritis headache is pain in the back of your head that gets worse when you move. It may be the result of arthritis in the first, second, or third vertebra of your spine. It also could be due to changes in the bone structure of your neck or inflamed blood vessels in your head.

Talk to your doctor about treatments. Usually you can treat these headaches with anti-inflammatory drugs, muscle relaxers, or both. Low-pressure headache. Spontaneous intracranial (SIH) is more commonly known as a low-pressure headache. This happens when there’s a spinal fluid leak in your neck or back.

  • The leak causes the cushion of spinal fluid around your brain to decrease.
  • Symptoms of SIH include intense pain in the back of your head and neck that gets worse when you stand or sit.
  • Low-pressure headaches usually get better after you lie down for half an hour.
  • Some people with SIH wake up with a mild headache that gets worse through the day.

See your doctor if you think you have SIH. They likely will use a series of tests and imaging studies to diagnose the condition. Most SIH patients find that typical headache treatments don’t work. Instead, they rely on a combination of caffeine, water, and lying down.

An outpatient procedure called an epidural blood patch is a common treatment that often works. For this procedure, your doctor draws blood from your arm and injects it into your lower spine. The headache goes away almost instantly, though you may have some lower back pain for up to a week (or in rare cases, even longer).

Occipital neuralgia. This rare type of headache involves pain in the occipital nerves. These run from your spinal cord up to your scalp. When they’re injured or inflamed, you may feel pain in the back of your head or behind your ears. People describe the pain as stabbing and severe – like a shock.

It can last for a few seconds to a few minutes. Afterward, you may feel a dull ache. Doctors aren’t sure what causes, The headache may come on when you do normal activities, such as brushing your hair or adjusting your head on your pillow. People with a whiplash injury or tumor may have it as a side effect.

Treatment generally includes warm compresses and gentle massage. Anti-inflammatory medications and muscle relaxers may help, too. If you have these headaches often, your doctor may prescribe antidepressants or antiepileptic drugs to lessen the attacks.

  • Cervicogenic headache.
  • This may feel like a headache with pain in the back of your head, but the issue actually is in the neck.
  • This is called referred pain, when you feel the pain in one part of your body but it’s really coming from somewhere else.
  • These don’t happen on their own – they’re a secondary headache, which means they are a sign of another medical issue.

This type of headache means there’s a problem with the bones, disks, or soft tissue in the neck such as:

Tumors Broken bones An infection

Symptoms of this type of headache include pain that gets worse with certain neck movements or when you touch your neck. You may find you have a limited range of motion. To diagnose cervicogenic headaches, your doctor will need to rule out other types of headache.

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