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For further information, see CMDT Part 8-06: Earache

Key Features

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



  • 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

  • Persistent earache demands specialty referral to exclude cancer of the upper aerodigestive tract

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