Otalgia

Question 1

sensory nerve supply to ear?

Answer 1

bottom half of ear + angle of mandible = greater auricular nerve (C2 and C3)
top half = mandibular nerve

Question 2

what is primary otalgia?

Answer 2

local pain from the site of problem

direct stimulation of the sensory nerve due to ear pathology

Question 3

causes of primary otalgia in external ear?

Answer 3

otitis externa (also causes discharge)
multiple other conditions of pinna and external auditory canal
chronic pain can be from malignancy or necrotising otitis externa (very painful)

Question 4

causes of primary otalgia in middle ear?

Answer 4

acute otitis media
mastoiditis
deep temporal bone and infratemporal fossa petrous apex erosion
can have infratemporal fossa tumour

Question 5

causes of primary otalgia in inner ear?

Answer 5

vestibular schwannoma (not all cases are painful)
can have CN deficits

Question 6

what is outer 2/3 of external ear (pinna and start of canal) made of?

Answer 6

cartilage

Question 7

what is inner 1/3 of external ear made of?

Answer 7

bone

Question 8

what marks the boundary between external and middle ear?

Answer 8

tympanic membrane

Question 9

otalgia can be referred via which nerves?

Answer 9

C2 and C3
CN V
CN IX
CN X

Question 10

C2 and C3 referred otalgia?

Answer 10

arthritis/cervical spondylosis

soft tissue injury

Question 11

CNV referred otalgia?

Answer 11

dental disease (tooth impaction, caries, abscesses etc)
TMJ dysfunction
nasopharyngeal disease (viral, tumour, post surgery)

Question 12

CN IX referred otalgia?

Answer 12

almost any oropharyngeal infective process (pharyngitis, tonsilitis, quinsy etc)
tongue base tumour

Question 13

CN X referred otalgia?

Answer 13

larynx and hypopharynx carcinoma

Question 14

what are the branches of the mandibular nerve?

Answer 14

auriculotemporal nerve

lingual nerve, buccal nerve, inferior alveolar nerve

Question 15

what does the mandibular nerve supply?

Answer 15

anterior 2/3 of tongue
inferior oral cavity
palate
lower teeth
mandible (including TMJ)
salivary glands

Question 16

how do pain signals in mandibular nerve get confused with those from the ear?

Answer 16

mandibular nerve and sensory nerve from the ear travel along same pathway (both go through foramen ovale)