Ear Pain (Otalgia) - Causes, Tests and Treatment

Otalgia: Pain Localised to The Ear

Ear ache, Otalgia, Ear Pain, Earache, Primary otalgia, Secondary otalgia
Pain in the ear area is called "otalgia" or "ear pain". The cause of ear pain can be an ear disease; It can occur with dental disease, tonsillitis, infectious diseases related to the nose and throat, diseases related to the temporomandibular joint (TMJ), laryngeal and tongue cancer, and sometimes it can occur as a sensory aura before migraine.

What is Primary Otalgia?

If the cause of ear pain is related to the ear, this condition is called "primary otalgia". Diseases causing primary otalgia may be related to the outer, middle or inner ear. The main diseases that may cause primary otalgia can be summarized as follows:

Related to the outer ear:

- Mechanical causes: due to trauma, foreign objects (insect, hair or cotton swabs)
- Infectious causes (otitis externa): may occur due to bacteria or fungi (ear fungus)

Related to the middle ear:

- Mechanical causes: barotrauma, pressure changes in the middle ear due to eustachian tube defects
- Infectious causes: Middle ear inflammation (acute otitis media) and acute mastoiditis.

What is Secondary Otalgia?

If ear pain is due to reasons originating from a region other than the ear, it is called “secondary otalgia / reflected otalgia / reflected ear pain / referenced otalgia”.

Reflected ear pain may occur due to 5 different nerves in this region.

- Trigeminal nerve (V. cranial nerve). Rarely, trigeminal neuralgia can cause otalgia. Oral cavity cancers can also cause ear pain reflected through this route.
- Conditions that can cause reflected pain associated with the facial nerve (VII. Cranial nerve / facial nerve), dental diseases (most often due to the upper molars), temporomandibular joint (temporomandibular joint dysfunction - due to its close relationship with the ear canal) and parotid gland (cheek major salivary gland) diseases.
- Conditions that may cause reflected pain associated with the glossopharyngeal nerve (IX. Cranial nerve), as well as infectious diseases in the throat area such as pharyngitis and tonsillitis; floor of the mouth, tongue root, soft palate, pharynx and tonsil cancers.
- Conditions that may cause reflected pain associated with the vagus nerve (X. cranial nerve X) are infectious diseases of the larynx and pharynx area, cancers and diseases such as reflux related to the esophagus.

Ear pain may also occur in stimuli from the C2 and C3 in the second and third spinal segments.

Differential Diagnosis in Ear Pain

In the ear nose and throat examination, many diseases that can cause ear pain can be detected. After excluding diseases related to the throat and ear, it is continued with jaw joint examination.

Causes of ear pain can be excluded based on the patient's history in the following cases:

- Ear pain that increases while eating may be more related to the jaw joint; rarely, it may be due to impacted teeth or other dental diseases. Since most of the patients who have problems with the jaw joint have tooth clenching (bruxism) at night, they may wake up with pain in the jaw and ear area.
- If there is hearing loss, fever and body malaise in addition to ear pain; Ear pain may be due to otitis media on the painful side.
- If there is an increased pain by pressing on the outer ear canal, the cause may be an external auditory canal infection.
If ear pain increases when you get angry and stressed, this may be part of migraine or tension pain.
- Especially in patients who use tobacco and alcohol, ear pain, which has been present continuously for a long time and gradually increasing, may be due to cancers of the upper part of the throat, tongue root or tonsil region.

Right sided tonsillitis
In the photo above, it was understood that the patient who described right ear pain had reflected ear pain due to right tonsillitis.

General Treatment Principles in Patients With Ear Pain

Treatment for diseases and conditions that cause ear pain should be planned. In addition to a simple external auditory canal inflammation, there are different options available in a wide range of treatment options, including the treatment of migraine or more difficult to treat diseases due to tooth clenching.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
E-Mail: muratenoz@gmail.com 
Mobile phone: +90 533 6550199
Fax: +90 212 542 74 47



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