Otalgia

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.

a.
CN V
Trigeminal Nerve
b.
CN VII
Facial Nerve
c.
CN IX
Glossopharyngeal Nerve
d.
CN X
Vagus Nerve
e.
C2 & C3
Cervical roots 2 & 3 via Occipital Nerves
pinna-sensation-for-web-small.gif
drum-sensation-medial-surface-for-web.gi
drum-sensation-lateral-for-web.gif

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

Tonsil
Tongue
Teeth
TMJ
Throat
The Neck
Tonsillitis, Tonsil Carcinoma
Tongue Carcinoma, Trauma
Teething, Tooth Abscess
TMJ Dysfunction
Carcinoma in Larynx or Pharynx
Inflammatory Neck Diseases

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.