Earache

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)

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

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

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