3. Otalgia

Otalgia (Earache)

This PatientPlus article is written for healthcare professionals so the language may be more technical than the condition leaflets. You may find the abbreviations list helpful.

Otalgia is aching or pain in the ear and causes can be primary, relating to the ear itself, or referred from sources outside the ear.

Causes of Otalgia
External ear causes
Middle ear causes
Referred pain
  • Nasopharynx - adenoidectomy, infection or neoplasm
  • Cranial nerve referred pain, eg Vth cranial nerve - trigeminal neuralgia, VIIth cranial nerve - Ramsay Hunt syndrome, glossopharyngeal or cranial nerve - tonsillitis
  • Salivary glands - calculi or infection
  • Teeth and jaw - impaction of molars, malocclusion, temporomandibular joint (TMJ) arthritis
  • Base of skull - elongated styloid process[3]
  • Petrous aneurysms[4]
  • Oesophagus - foreign body, reflux or neoplasm
  • Inflammation or neoplasm of oropharnyx, tongue or larynx
  • Temporal arteritis
  • Thyroidits

Otalgia is very common, especially in children, and most cases are transient.

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  • History - especially pertaining to onset, precipitating factors, eg noise, duration, discharge, fever, swallowing disorder, dental history
  • Examination - auroscopy looking for causes, eg otitis media, cerumen
  • If auroscopy unremarkable, consider referred causes of pain and examine cranial nerves, especially Vth, IXth and Xth
  • Also examine - the nose, sinuses, oropharynx and nasopharynx (occult carcinoma often presents with otalgia), TMJ , parotid glands, larynx, trachea
  • Check temperature
  • Investigations depend on the suspicion from the history and examination - the following can be performed FBC, TFTs, ESR, chest X-ray and audiography

Always consider neoplastic causes in both children and adults with persistent otalgia. Other red flags include weight loss, voice change, lymphadenopathy and dysphagia[5]

  • Analgesia
  • Treat underlying cause
  • If no cause found, consider re-reviewing the patient in a few days
  • If pain continues and still the cause is unclear, consider referral to specialist - there is an almost 20% risk of a sinister cause of otalgia[6]

Almost 50% will have spontaneous resolution of otalgia with no underlying cause detectable.[6]

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Further reading & references

  1. Erkalp K, Kalekoglu Erkalp N, Ozdemir H; Acute otalgia during sleep (live insect in the ear): a case report. Agri. 2009 Jan;21(1):36-8.
  2. Kumon Y, Kakigi A, Sugiura T; Clinical images: Otalgia, an unusual complication of Sjogren's syndrome. Arthritis Rheum. 2009 Aug;60(8):2542.
  3. Prabhu LV, Kumar A, Nayak SR, et al; An unusually lengthy styloid process. Singapore Med J. 2007 Feb;48(2):e34-6.
  4. Coley S, Clifton A, Britton J; An unusual cause of otalgia. AJNR Am J Neuroradiol. 1998 Sep;19(8):1452-3.
  5. Majumdar S, Wu K, Bateman ND, et al; Diagnosis and management of otalgia in children. Arch Dis Child Educ Pract Ed. 2009 Apr;94(2):33-6.
  6. Charlett SD, Coatesworth AP; Referred otalgia: a structured approach to diagnosis and treatment. Int J Clin Pract. 2007 Jun;61(6):1015-21.
Original Author: Dr Gurvinder Rull Current Version:
Last Checked: 11/12/2009 Document ID: 2551  Version: 21 © EMIS

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.