Earache

Key Features

• 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

• 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

• Pneumatic otoscopy should differentiate between external otitis and acute otitis media (see Otitis, External and Otitis Media, Acute)

Treatment

• 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