Ear pain, or otalgia, is discomfort localised to or referred toward the ear, and it is a common presenting symptom across all age groups. It is classified by origin as primary, or otogenic, when it arises from disease of the ear itself, and secondary, or referred, when it is generated by pathology in structures that…
Ear pain, or otalgia, is discomfort localised to or referred toward the ear, and it is a common presenting symptom across all age groups. It is classified by origin as primary, or otogenic, when it arises from disease of the ear itself, and secondary, or referred, when it is generated by pathology in structures that share sensory innervation with the ear. Primary causes include otitis externa, acute and chronic otitis media, tympanic membrane perforation, impacted cerumen, barotrauma and congenital or acquired lesions such as cholesteatoma, sometimes associated with aural atresia. Referred otalgia reflects the rich innervation of the ear by several cranial and cervical nerves and may originate from dental and oral disease, the temporomandibular joint, the pharynx and larynx, the cervical spine, or neuralgic conditions, including those investigated through cervical medial branch blocks in the context of somatosensory tinnitus. Evaluation combines otoscopic examination and hearing assessment with a search for non-otological sources when the ear appears normal, since the underlying cause may be benign or, occasionally, a manifestation of serious disease such as malignancy. Treatment is directed at the cause, ranging from management of infection and cerumen removal to surgical procedures such as tympanoplasty and treatment of referred sources. Accurate identification of whether otalgia is primary or referred guides effective management.
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