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【医療翻訳に役立つ基礎知識】No.16 | 耳鼻咽喉科疾患の主訴 Vol.1

Ear pain (Otalgia: Ear Pain)

Etiology (Etiology) and diagnostics to help findings (Signs)

1.Ear (Outer Ear) disease

Outside the ear (Outer Ear) is eardrum (tympanic membrane), consisting of the ear canal (External ear canal) and pinna (Pinna).Eardrum belongs to the middle ear.

The outer ear disease complain of ear pain,

  • Otitis externa (Otitis externa) Example:Skin infections caused by Staphylococcus aureus (such as infection after ear wax removal)
  • The ear canal foreign body (Ear canal foreign bodies) Example:Children insert foreign objects into the ear canal
  • Ear canal stenosis or occlusion by earwax (Ear wax)
  • and so on.

Otitis externa of adults, often staphylococcal infection of the skin lesions caused by ear.Normally, even without taking antibiotics, to heal naturally in a few days.

In otitis externa, and pull the pinna (Pulling on the ear) pain is induced.Pull the ear, if shouted by the patient as "painful", was diagnosed with otitis externa, almost certainly.

2.Middle ear (Middle Ear) disease

Acute otitis media (Acute otitis media)

Among the disease complain of ear pain, the most frequent otitis media.Otitis media is often in children, including infants.In infants, even if there is ear pain, communicate is insufficient, we may not know an adult.Thus, even without the presence or absence of ear pain is clearly, in children, if there is a fever and upper respiratory tract infection, complications of acute otitis media, always it is necessary to take into account.

Acute otitis media, upper respiratory tract (Upper airway:Larynx, Eustachian tube connecting the throat) and tympanic (tympanic cavity) through (Eustachian tube), from the upper respiratory tract to the middle ear, caused by infection is enlarged.The cause is often a bacterial infection of Streptococcus pneumoniae, such as Haemophilus influenzae, but also of the virus infection.If the Eustachian tube in the vent pipe for equalizing the tympanic pressure and outside air pressure, there is a tubal occlusion or stenosis, sharp fluctuations in the external atmospheric pressure (e.g.When the train entered the tunnel, at the sudden rise or descent of the aircraft, such as by), since the pressure difference between the inside of the eardrum (tympanic) and outside (external auditory canal) occurs, the tympanic membrane is expanded or recessed, ear pain or ringing in the ears cause of.In such a case, the operation to swallow, open ear canal, because there is no pressure difference between the atmosphere and the tympanic cavity pressure, ear pain quickly disappeared.Tinnitus and ear pain when entering the tunnel, it was improved by the operation swallow, should that probably everyone is experienced.Slap and ears, eardrum damage, such as the tympanic membrane rupture due to blast (Barotrauma) (Injuries to the tympanic membrane) is also a cause of ear pain.

In there was no hearing loss in children, they rely on mechanical watches to the left and right ears, on the one hand, if you can not hear on the other hand to hear, suspect ear canal obstruction due to earwax, or otitis media possibilities immediately.

Diagnosis of otitis media, medical history, along with the clinical symptoms such as ear pain, redness of the eardrum, if there is a finding, such as swelling, may be thought that almost certainly.

3.Radiating pain (Referred pain)

Ear and temporomandibular joint (Temporo-mandibular joint, TMJ), the upper molars, cervical, Shitasoko part, of the sensory nerves, such as the pharynx distribution, are quite duplicate.Thus, for example, when the inflammation occurs in the jaw joint, pain is sometimes feel as ear pain.In patients with ear pain, if there is no abnormality in the eardrum, it is necessary to consider the possibility of radiating pain from a site other than the ear.

Large can not open mouth, bites down when the pain is enhanced, and is a symptom suggestive of jaw arthritis, was admitted to dental the day before the ear pain appearance, if there is a history of, etc., of the tooth disease related it is necessary to doubt.

Hearing loss (Hearing Impairment), hearing loss (Hearing loss)

Ear pain in children, hearing loss is greater in the elderly.Hearing loss due to aging (especially hearing loss of treble range above 4000 Hz) are individual differences there are may think 必発.

Sound waves, through the ① ear canal, eardrum (Tympanic membrane, Ear drum) of ➁ middle ear to vibrate the, ③ auditory ossicles through the (Ossicules, Tutsi (Malleus), incus (Incus), stirrups (Stapes)) is converted into an electric signal by ④ inner ear cochlear (cochlea), through ⑤ auditory nerve (auditory nerve 8th cranial nerve (eighth cranial nerve), ⑥ reach cerebral auditory area, it is recognized as sound.Hearing impairment can also occur by the lesion site of ① ~ ⑥ throat.

Classification

伝音性難聴(Conductive hearing loss)
①~③の障害による難聴(外耳、中耳疾患による難聴 例 耳垢による耳道閉塞)

感音性難聴(Sensory-neural hearing loss)
④~⑥の障害による難聴(内耳、聴覚神経、大脳聴覚領域の病変による難聴)

In general, hearing loss in children conductive hearing deafness, and the elderly, drug side effects (for example:Streptomycin) by hearing loss is often sensorineural hearing loss.Adult of sudden deafness (Sudden sensory neural hearing loss SSNHL) is also a sensorineural hearing loss.Ear canal blockage by ear wax accounts for about 30% of the cause of the elderly hearing loss.Since hearing is improved by removing earwax, when examination deafness of the elderly must not neglect the outer ear of the observation.


Prognosis (Prognosis)

Many conductive hearing deafness, but prognosis is good, improvement of hearing loss due to chronic otitis media, not normally expected.Senile sense of sound-induced hearing loss (Prebycusis), Meniere's disease (Meniere's disease), hearing loss due to many years of noise, drug-induced hearing loss caused by streptomycin and anti-cancer agents are also prognosis is poor, such as the use of hearing aids, is a certain degree of support possible , progress with age can not be avoided.

突発性難聴(SSNHL)の70~90%は、ほぼ完全に回復する。同じ薬剤性難聴でも、アスピリンや抗マラリア剤、ループ利尿剤による難聴は予後は比較的良好である。

関連記事

Masashi Mori

Masashi Mori

Towa hospital honor director.The University of Tokyo School of Medicine, Department of Medicine graduation.US University of Minnesota study (Fulbright scholarship) Minneapolis Mount Sinai Hospital work.After returning home, the University of Tokyo second medical assistant, University of Tokyo Hospital central laboratory lecturer, held a Mitsui Memorial Hospital Respiratory Center Hospital Director, appointed to the National Hospital Organization Tokyo hospital honor director in 2003.Then chemotherapy Institute Hospital director, is now through the Towa hospital director Towa hospital honor director.

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