II. Physiology

  1. Ear shares sensory fibers from head, neck and chest
    1. Trigeminal Nerve (CN 5)
    2. Facial Nerve (CN 7)
    3. Glossopharyngeal Nerve (CN 9)
    4. Vagus Nerve (CN 10)
    5. Cervical nerves (C2 and C3)
  2. Primary Ear Pain sources
    1. Auricle (CN 5, 7, 10 and C2-3)
    2. External auditory canal (CN 5,7, 10)
    3. Tympanic Membrane (CN 7, 9, 10)
    4. Middle Ear (CN 5, 7, 9)

III. History

  1. Pain location, duration
  2. Palliative and provocative factors
  3. Prior episodes of Ear Pain
  4. Tobacco Abuse
  5. Alcohol Abuse
  6. Associated symptoms suggestive of primary Otalgia
    1. Otorrhea
    2. Tympanic Membrane fullness
    3. Vertigo
    4. Hearing Loss
    5. Continuous and progressive Ear Pain
  7. Associated symptoms suggestive of secondary Otalgia
    1. Pain worse with chewing
    2. Sinusitis
    3. Dental procedures
    4. Gastroesophageal Reflux
    5. Hearing Loss absent
    6. Intermittent Ear Pain

IV. History: Red Flags to suggest secondary cause

  1. Age over 50 years (malignancy, Temporal Arteritis)
  2. Excessive Tobacco use (malignancy, vascular disease)
  3. Cardiac Risk Factors (Coronary Artery Disease, thoracic aneurysm)

V. Exam

  1. External Ear exam
    1. Auricle
    2. Periauricular area
  2. Otoscopy
    1. External auditory canal
    2. Tympanic Membrane
  3. Mouth Exam
    1. Dental Infection or Dental Pain
    2. Pharyngitis
  4. Nasal Exam
    1. Paranasal Sinus tenderness
  5. Other regional exam
    1. Temporomandibular Joint exam

VII. Causes: Secondary, Referred Pain (40-50% of Otalgia cases)

  1. Common
    1. Dental causes (38%) such as Dental Caries, Periodontal Abscess
    2. Temporomandibular Joint Disorders (35%)
    3. Cervical Spine disorders (8%) or Myofascial Pain
    4. Parotitis
    5. Pharyngitis
  2. Uncommon: Urgent
    1. Head and Neck tumors
    2. Temporal Arteritis
    3. Carotidynia
    4. Angina Pectoris or Acute Coronary Syndrome
    5. Thoracic aneurysym
  3. Uncommon: Other
    1. Bell's Palsy
    2. Eagle's Syndrome (styloid process elongation)
    3. Gastroesophageal Reflux
    4. Oral Aphthous Ulcers
    5. Periauricular or cervical adenitis
    6. Sialolithiasis
    7. Sinusitis
    8. Thyroiditis (rare cause of isolated Otalgia)
    9. Trigeminal Neuralgia and other regional Neuropathy (5%)

VIII. Evaluation: Secondary Ear Pain (no primary ear source identified)

  1. Malignancy risk factors (age >50, Tobacco Abuse, Alcohol Abuse, weight loss)
    1. Nasolaryngoscopy
    2. CT or MRI imaging
    3. Otolaryngology
  2. Temporal Arteritis (age >50, Jaw Claudication, Polymyalgia Rheumatica)
    1. Erythrocyte Sedimentation Rate (>50 mm/h)
  3. Suspected thoracic source (e.g. Coronary Artery Disease)
    1. Electrocardiogram
    2. Chest XRay
    3. Evaluate for Coronary Artery Disease, thoracic aorta
  4. Temporomandibular Joint Dysfunction or dental source
    1. Symptomatic management (NSAIDs, soft diet)
    2. Dental referral (or Temporomandibular Joint clinic)

IX. Management

  1. Treat underlying cause
  2. Systemic Analgesics (e.g. Acetaminophen, Ibuprofen)
  3. Topical Anesthetics (if no TM Rupture)
    1. Aurodex (Benzocaine and Antipyrine)
      1. Not available in U.S. as of 2016
      2. Risk of Contact Dermatitis (use with caution)
      3. Risk of methhemoglobinemia (do not use under age 2 years)
      4. Avoid Auralgan (expensive trade name replacement) without improved efficacy

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Related Studies

Ontology: Earache (C0013456)

Definition (NCI) Painful sensation in the ear region.
Definition (NCI_CTCAE) A disorder characterized by a sensation of marked discomfort in the ear.
Definition (MSH) Pain in the ear.
Concepts Sign or Symptom (T184)
MSH D004433
ICD9 388.70, 388.7
ICD10 H92.0 , H92.09
SnomedCT 194408009, 16001004, 162356005, 194407004, 162361007, 302219006, 139630001, 155251005, 194406008, 139625000
English Earaches, Otalgia, Otalgias, EAR PAIN, Otalgia, unspecified, Earache symptom NOS, Unspecified otalgia, EAR ACHE, Otalgia NOS (disorder), Otalgia (finding), Earache symptom (finding), Unspecified otalgia (disorder), Earache symptoms (disorder), Earache symptom, Earache symptom NOS (disorder), ear ache, earache, earache (diagnosis), earache (symptom), ear pain, Earache, Pain ear, Otalgia NOS, Ear Pain, Otalgia, unspecified ear, Earache [Disease/Finding], earaches, ears pain, pain in ear, Pain;ear, pain in the ear, ear aches, ear pains, Earache symptom NOS (finding), Otalgia NOS (finding), Unspecified otalgia (finding), (Otalgia) or (ear pain), Otalgia (disorder), (Otalgia) or (ear pain) (disorder), Earache symptoms (finding), Ear pain (finding), Ear ache, Earache symptoms, Pain in ear, Ear pain, otalgia, ear; pain, pain; ear, Earache, NOS, Otalgia, NOS, Pain in ear, NOS, Earache NOS
French OTALGIE, Douleur dans l'oreille, Otalgie, non précisée, Maux d'oreille, Douleur auriculaire, Otalgie, Otodynie
Portuguese DOR DE OUVIDO, OTALGIA, Otalgia NE, Dor de Ouvido, Dor de ouvidos, Dor de Orelha, Otalgia
German OHRENSCHMERZEN, Schmerz im Ohr, Schmerz, Ohr, Ohrenschmerz, Otalgie, unspezifisch, SCHMERZEN OHR, Ohrschmerzen, Ohrenschmerzen, Otalgie
Spanish OTALGIA, Dolor de oído, Dolor en oído, Otalgia no especificada, síntoma de otalgia, SAI (trastorno), otalgia (trastorno), síntomas de dolor ótico, otalgia (hallazgo), otalgia no especificada (trastorno), otalgia, SAI (trastorno), síntoma de dolor de oído, OIDO, DOLOR, síntomas de dolor ótico (trastorno), síntoma de dolor de oído (hallazgo), síntoma de otalgia, SAI (hallazgo), otalgia, SAI, Earache symptom NOS, síntoma de otalgia, SAI, otalgia, SAI (hallazgo), síntoma de dolor de oído, SAI, otalgia no especificada (hallazgo), otalgia no especificada, dolor de oídos, dolor en el oído, otalgia, Dolor de oídos, Otalgia, Dolor de Oído
Dutch pijn oor, otalgie, pijn in het oor, niet-gespecificeerde otalgie, oor; pijn, pijn; oor, Otalgie [oorpijn], oorpijn, Oorpijn, Otalgie, Pijn, oor-
Italian Dolore auricolare, Dolore all'orecchio, Otalgia, non specificata, Otalgia
Japanese 詳細不明の耳痛, ミミツウ, ショウサイフメイノジツウ, ジツウ, 耳痛
Swedish Öronvärk
Finnish Korvakipu
Czech Bolení ucha, Bolest v uchu, Otalgie, blíže neurčená, Otalgie, Bolest ucha, otalgie, bolesti ucha, bolest ucha, bolest v uchu, ucho - bolest
Korean 귀통증
Polish Ból ucha, Otalgia
Hungarian Fül fájdalma, Nem meghatározott otalgia, fül fájdalom, Fülfájás, Otalgia, Fülfájdalom, Fájdalom a fülben
Norwegian Øresmerte, Otalgi, Øresmerter, Øreverk