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
Otalgia is very common, especially in children, and most cases are transient.
Approach to the patient with otalgia
- History - especially pertaining to onset, and precipitating factors - eg, noise, duration, discharge, fever, swallowing disorder, dental history.
- Examination - auroscopy looking for causes - eg, otitis media, cerumen.
- If auroscopy is unremarkable, consider referred causes of pain and examine the cranial nerves, especially V, IX and X.
- Also examine - the nose, sinuses, oropharynx and nasopharynx (occult carcinoma often presents with otalgia), TMJ , parotid glands, larynx, and trachea.
- Check temperature.
- Investigations depend on the suspicion from the history and examination - the following can be performed: FBC, TFTs, ESR, CXR and audiography.
Always consider neoplastic causes, both in children and in adults with persistent otalgia. Other red flags include weight loss, voice change, lymphadenopathy and dysphagia.
- Treat the underlying cause.
- If no cause is found, consider re-reviewing the patient in a few days.
- If pain continues and still the cause is unclear, consider referral to specialist to exclude a sinister cause of otalgia.
Almost 50% of patients will have spontaneous resolution of otalgia with no underlying cause detectable.
Further reading and references
Barotrauma; American Hearing Research Foundation
Kim KS; Referred otalgia induced by a large tonsillolith. Korean J Fam Med. 2013 May34(3):221-3. doi: 10.4082/kjfm.2013.34.3.221. Epub 2013 May 24.
Siupsinskiene N, Padervinskis E, Poskiene L, et al; An unusual case of a sore throat and otalgia in a 4-year-old boy. Medicina (Kaunas). 201248(5):277-9.
Birnbaum J; Facial Weakness, Otalgia, and Hemifacial Spasm: A Novel Neurological Syndrome in a Case-Series of 3 Patients With Rheumatic Disease. Medicine (Baltimore). 2015 Oct94(40):e1445. doi: 10.1097/MD.0000000000001445.