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Medical Professionals

Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European Guidelines. You may find one of our health articles more useful.

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What is otalgia?

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 (aetiology)

External ear causes

Middle ear causes

Referred pain

Otitis externa.

Foreign body - including live insects.


Impacted cerumen.

Bullous myringitis.


Herpes zoster.



Perichondritis of pinna.

Sjögren's syndrome.

Otitis media.

Effusion associated with otitis media.

Acute mastoiditis.


Acute obstruction of Eustachian tube.



Nasopharynx - adenoidectomy, infection or neoplasm.

Cranial nerve referred pain (eg, Vth cranial nerve - trigeminal neuralgia, VIIth cranial nerve - Ramsay Hunt syndrome, glossopharyngeal or cranial nerve - tonsillitis).

Migraine - likely due to trigeminal nerve activation.

Salivary glands - calculi or infection.

Teeth and jaw - impaction of molars, malocclusion, temporomandibular joint (TMJ) arthritis.

Base of skull - elongated styloid process.

Petrous aneurysms.

Oesophagus - foreign body, reflux or neoplasm.

Inflammation or neoplasm of oropharynx, tongue or larynx.

Temporal arteritis.


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How common is otalgia? (Epidemiology)

Otalgia is very common, especially in children, and most cases are transient.1

Approach to the patient with otalgia

  • History - especially pertaining to onset, and precipitating factors - eg, noise, duration, discharge, fever, swallowing disorder, dental history.

  • Examination - otoscopy looking for causes - eg, otitis media, cerumen.

  • If otoscopy is unremarkable, consider referred causes of pain and examine the cranial nerves, especially V, VII, IX and X.

  • Also examine - the nose, sinuses, oropharynx and nasopharynx (occult carcinoma often presents with otalgia), cervical lymph nodes, 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 audiogram.

Always consider neoplastic causes, both in children and in adults with persistent otalgia. Other red flags include weight loss, voice change, lymphadenopathy and dysphagia.

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Management of otalgia

  • Analgesia.

  • 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 a specialist referral to exclude a sinister cause of otalgia.


Almost 50% of patients will have spontaneous resolution of otalgia with no underlying cause detectable.2

Further reading and references

  • 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). 2012;48(5):277-9.
  • Kim KS; Referred otalgia induced by a large tonsillolith. Korean J Fam Med. 2013 May;34(3):221-3. doi: 10.4082/kjfm.2013.34.3.221. Epub 2013 May 24.
  • 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 Oct;94(40):e1445. doi: 10.1097/MD.0000000000001445.
  • Wright T; Middle-ear pain and trauma during air travel. BMJ Clin Evid. 2015 Jan 19;2015. pii: 0501.
  • Coulter J, Kwon E; Otalgia.
  • Norris CD, Koontz NA; Secondary Otalgia: Referred Pain Pathways and Pathologies. AJNR Am J Neuroradiol. 2020 Dec;41(12):2188-2198. doi: 10.3174/ajnr.A6808. Epub 2020 Oct 22.
  • Maharaj S, Bello Alvarez M, Mungul S, et al; Otologic dysfunction in patients with COVID-19: A systematic review. Laryngoscope Investig Otolaryngol. 2020 Nov 17;5(6):1192-1196. doi: 10.1002/lio2.498. eCollection 2020 Dec.
  • Kasinathan S, Kondamudi NP; Bullous Myringitis.
  1. Harrison E, Cronin M; Otalgia. Aust Fam Physician. 2016 Jul;45(7):493-7.
  2. Charlett SD, Coatesworth AP; Referred otalgia: a structured approach to diagnosis and treatment. Int J Clin Pract. 2007 Jun;61(6):1015-21.

Article history

The information on this page is written and peer reviewed by qualified clinicians.

  • Next review due: 19 Sept 2028
  • 21 Sept 2023 | Latest version

    Last updated by

    Dr Surangi Mendis

    Peer reviewed by

    Dr Pippa Vincent, MRCGP
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