There are just three basic facts that you need to know about otalgia:

1.   It is either due to ear disease or it is referred
2.  The sensory supply to the skin and mucosa of the ear
3.  Structures in the head and neck that begin with 'T' - mostly

1. Ear disease or not ear disease


Almost all inflammatory or infective conditions of the pinna, outer ear canal, ear drum and middle ear can cause pain. Trauma does as well, as can carcinoma of the pinna and middle ear (very rare).
Common causes are otitis externa and otitis media.


However, it must be remembered that pain may be referred to the ear from another source. This is referred or non-otogenic pain. If a patient complains of otalgia and has a normal looking ear then a search must begin with all the sites that are known to refer pain to the ear - see section 3 (all the 'T's).

2. The sensory supply to the skin and mucosa of the ear

There are many nerves that give sensation to the outer and middle ear. You should know them all.

3. Causes of referred otalgia - structures beginning with 'T'

A patient comes in complaining of ear pain...


History and examination will quickly determine whether the pain is arising from ear disease or whether the pain is referred.

If the ear looks normal then search for the cause of the pain by examining the oral cavity, pharynx, larynx, temporomandibular joint and muscles of mastication, and teeth.


This is critically important as referred otalgia is one of the red flag symptoms or carcinoma in the mouth, pharynx and larynx.

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