Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 8-06: Earache + Key Features Download Section PDF Listen +++ ++ Earache can be caused by a variety of otologic problems, but external otitis and acute otitis media are most the common (see Otitis, External and Otitis Media, Acute) + Clinical Findings Download Section PDF Listen +++ ++ Pain out of proportion to the physical findings may be due to herpes zoster oticus, especially when vesicles appear in the ear canal or concha Persistent pain and discharge from the ear suggest osteomyelitis of the skull base or cancer Nonotologic causes of otalgia are numerous The sensory innervation of the ear is derived from the trigeminal, facial, glossopharyngeal, vagal, and upper cervical nerves Because of this rich innervation, referred otalgia is quite frequent Temporomandibular joint dysfunction Common cause of referred ear pain Pain is exacerbated by chewing or psychogenic grinding of the teeth (bruxism) and may be associated with dental malocclusion Repeated episodes of severe lancinating otalgia may occur in glossopharyngeal neuralgia Infections and neoplasia that involve the oropharynx, hypopharynx, and larynx frequently cause otalgia + Diagnosis Download Section PDF Listen +++ ++ Pneumatic otoscopy should differentiate between external otitis and acute otitis media (see Otitis, External and Otitis Media, Acute) + Treatment Download Section PDF Listen +++ ++ For temporomandibular joint dysfunction Soft diet Local heat to the masticatory muscles Massage Nonsteroidal anti-inflammatory medications Dental referral For glossopharyngeal neuralgia, carbamazepine 100–300 mg orally every 8 hours often confers substantial symptomatic relief