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.

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

• 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

• 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

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