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This article is for 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 the Barotrauma to the Ear (Stretched Eardrum) article more useful, or one of our other health articles.

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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
Referred pain

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

  • 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.

  • 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]

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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.

  • 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.

  • Coulter J, Kwon E; Otalgia.

  • Norris CD, Koontz NA; Secondary Otalgia: Referred Pain Pathways and Pathologies. AJNR Am J Neuroradiol. 2020 Dec41(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 175(6):1192-1196. doi: 10.1002/lio2.498. eCollection 2020 Dec.

  • Wright T; Middle-ear pain and trauma during air travel. BMJ Clin Evid. 2015 Jan 192015. pii: 0501.

  • Kasinathan S, Kondamudi NP; Bullous Myringitis.

  1. Harrison E, Cronin M; Otalgia. Aust Fam Physician. 2016 Jul45(7):493-7.

  2. Charlett SD, Coatesworth AP; Referred otalgia: a structured approach to diagnosis and treatment. Int J Clin Pract. 2007 Jun61(6):1015-21.