Earache (otalgia)

Question 1

What are aural causes for otalgia?

Answer 1

• OUTER EAR:
  
  • perichondritis
  • otitis externa
  • furuncle
• MIDDLE EAR:
  
  • acute otitis media
  • bullous myringitis → painful haemorrhagic blisters on TM
  • barotrauma

Question 2

What are non-aural causes of otalgia (make up 50% of causes)?

Answer 2

• CN V → auricotemporal nerve (branch of CN V₃) supplies lateral upper half of pinna, it may refer pain from dental disease (eg. dental caries, impacted molars) or TMJ dysfunction
• VII → sensory branch of CN VII supplies lateral surface of TM + refers pain in geniculate herpes
• IX (rare) → primary glossopharyngeal neuralgia may cause ear pain on swallowing
• IX + X → supply medial half of TM + may refer pain from tongue, larynx or throat to the eat eg. tonsillitis, quinsy, post-tonsillectomy
• greater auricular (C2, 3) + lesser occipital (C2) nerves → supply lower half of pinna, may refer pain from soft tissue injury in neck + cervical spondylitis or arthritis

Question 3

Which nerves may give rise to referred ear pain?

Answer 3

• auricotemporal (branch of V3)
• glossopharyngeal nerve
• auricular branch of vagus nerve
• great auricular nerve
• lesser occipital nerve
• facial nerve via nervus intermedius