Otalgia

Otalgia is ear pain. The term encompasses pain arising from the ear itself (primary otalgia) and pain referred to the ear from nearby structures (referred otalgia). It can be acute or chronic and requires evaluation to identify the underlying cause.

Causes

- Primary otalgia (ear pathology): otitis externa, acute otitis media, otitis interna, cerumen impaction, foreign body in the ear, tympanic membrane perforation, eustachian tube dysfunction with middle ear effusion, barotrauma, and, less commonly, tumors of the ear canal or middle ear.

- Referred otalgia: temporomandibular joint disorders, dental problems (toothache), trigeminal or glossopharyngeal neuralgia, pharyngitis or tonsillitis, sinusitis, cervical spine disorders, throat or nasopharyngeal tumors.

- Other factors: sequelae of upper respiratory infections, hematologic or systemic illnesses in rare cases.

Evaluation

A focused history and physical examination are essential. Key questions include onset, duration, character, triggers, hearing changes, vertigo, discharge, fever, recent dental or throat symptoms, and exposure to loud noise. The exam typically includes otoscopy to assess the tympanic membrane, middle ear, and canal; cleaning or cerumen removal if appropriate; and examination of the oropharynx, jaw, teeth, and neck. Red flags warrant urgent evaluation: severe, intractable pain with fever or neuro signs, facial weakness, persistent otorrhea, suspected mastoiditis, or unilateral hearing loss.

Management

Treatment targets the underlying condition and may include analgesia (paracetamol or NSAIDs), topical or oral antibiotics for bacterial infections, and appropriate management of dental, ENT, or TMJ issues. Safe ear care includes avoiding cotton swabs and not inserting fluids or medications into a possibly perforated tympanic membrane. Referral to ENT may be needed for persistent, unclear, or complicated cases.

Prognosis

Most cases resolve with appropriate treatment of the underlying cause. Chronic otalgia may require multidisciplinary evaluation to identify noninfectious or referred etiologies.