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For further information, see CMDT Part 8-06: Earache
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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
Repeated episodes of severe lancinating otalgia may occur in glossopharyngeal neuralgia
Infections and neoplasia that involve the oropharynx, hypopharynx, and larynx frequently cause otalgia
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For temporomandibular joint dysfunction
For glossopharyngeal neuralgia, carbamazepine 100–300 mg orally every 8 hours often confers substantial symptomatic relief
Persistent earache demands specialty referral to exclude cancer of the upper aerodigestive tract