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PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people.

Otalgia (Earache)

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
Causes of Otalgia
External ear causes
Middle ear causes
Referred pain
  • Nasopharynx - adenoidectomy, infection or neoplasm
  • Cranial nerve referred pain - e.g. 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, TMJ arthritis
  • Base of skull - elongated styloid process1
  • Petrous aneurysms2
  • Oesophagus - foreign body, reflux or neoplasm
  • Inflammation or neoplasm of oropharnyx, tongue or larynx
  • Temporal arteritis
  • Thyroidits
Epidemiology

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

Approach to patient with otalgia
  • History - especially pertaining to onset, precipitating factors e.g. noise, duration, discharge, fever, swallowing disorder, dental history
  • Examination - auroscopy looking for causes e.g. 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, oro- 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, TFT's, ESR, chest X ray and audiography
Management
  • 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 otalgia3
Prognosis

Almost 50% will have spontaneous resolution of otalgia with no underlying cause detectable3

Document References
  1. Prabhu LV, Kumar A, Nayak SR, et al; An unusually lengthy styloid process. Singapore Med J. 2007 Feb;48(2):e34-6. [abstract]
  2. Coley S, Clifton A, Britton J; An unusual cause of otalgia. AJNR Am J Neuroradiol. 1998 Sep;19(8):1452-3.
  3. Charlett SD, Coatesworth AP; Referred otalgia: a structured approach to diagnosis and treatment. Int J Clin Pract. 2007 Jun;61(6):1015-21. [abstract]
Acknowledgements EMIS is grateful to Dr Gurvinder Rull for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2007.
DocID: 2551
Document Version: 20
DocRef: bgp924
Last Updated: 2 Oct 2007
Review Date: 1 Oct 2009


















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PS - Health and Poverty

Perhaps the biggest cause of ill health in the world is poverty. Help to Make Poverty History. For example, why not lend some of your money to disadvantaged communities to enable them to trade their way out of poverty through schemes such as Shared Interest.

See also MAKEPOVERTYHISTORY North East for details and links to campaigns against poverty.

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