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 in both children and 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 - there is an almost 20% risk of a sinister cause of otalgia.
Almost 50% of patients will have spontaneous resolution of otalgia with no underlying cause detectable.
Further reading and references
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.
Mistry D, Atkinson H; An itchy ear that became painful. BMJ. 2009 Sep 16339:b3632. doi: 10.1136/bmj.b3632.
Erkalp K, Kalekoglu Erkalp N, Ozdemir H; Acute otalgia during sleep (live insect in the ear): a case report. Agri. 2009 Jan21(1):36-8.
Kumon Y, Kakigi A, Sugiura T; Clinical images: Otalgia, an unusual complication of Sjogren's syndrome. Arthritis Rheum. 2009 Aug60(8):2542.
Thotappa LH, Doni BR; Oropharyngeal styloids: an unusual presentation. Indian J Dent Res. 2012 Jul-Aug23(4):559. doi: 10.4103/0970-9290.104980.
Moonis G, Hwang CJ, Ahmed T, et al; Otologic manifestations of petrous carotid aneurysms. AJNR Am J Neuroradiol. 2005 Jun-Jul26(6):1324-7.
Majumdar S, Wu K, Bateman ND, et al; Diagnosis and management of otalgia in children. Arch Dis Child Educ Pract Ed. 2009 Apr94(2):33-6.
Charlett SD, Coatesworth AP; Referred otalgia: a structured approach to diagnosis and treatment. Int J Clin Pract. 2007 Jun61(6):1015-21.
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