Otalgia
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| ICD-10 | H60. Otitis Externa H65.&H66. Otitis Media H92. Otalgia |
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| ICD-9 | 380.1 Otitis Externa 381 Otitis Media 388.7 Otalgia |
| DiseasesDB | 18027 |
| eMedicine | ent/199 |
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Overview
Otalgia is ear pain or an earache. Primary otalgia is from pain that originates inside the ear. Referred otalgia is from pain that originates from outside the ear. Otalgia is not always associated with ear disease. It may be caused by several other conditions, such as impacted teeth, sinus disease, inflamed tonsils and infections in the nose and pharynx. The most common causes of ear pain can be identified though the description of the character, onset, and location (coupled with a physical examination).
Ear pain is usually broken into two categories:
- Otitis media (infection/inflammation of the inner ear). In Otitis media, most cases are viral in origin.
- Otitis externa: Outer ear canal infection. In Otitis externa, movement of tragus causes pain.
Epidemiology
Otitis Media
- Male>female
- Peak incidence is 6-18 months
Risk Factors for Otitis Media
- Anatomic abnormalities
- Day care
- Siblings with otitis media
- Smoking in household
- Supine bottles
Complete Differential Diagnosis of Otalgia
- Acoustic nerve tumor
- Acute otitis externa (Swimmer's ear)
- Acute otitis media
- Arthritis of the temporomandibular joint
- Auricular erysipelas
- Auricular perichondritis
- Cellulitis
- Cerumen impaction
- Cervical spine disease
- Cholesteatoma
- Chronic otitis externa
- Ear canal foreign body
- Eczema
- Eustachion tube dysfunction
- Eustachion tube syringitis
- Furunculosis
- Herpes Zoster Oticus
- High altitude sickness
- Malignant otitis externa
- Mastoiditis
- Mumps
- Myringitis bullosa
- Other acute barotrauma
- Psoriasis
- Reaction to topical agents
- Ruptured or perforated eardrum
- Sterile middle ear effusion
- Trauma
- Tumor
- Tympanostomy tube obstruction
- Varicella
Referred Pain
- Acute Coronary Syndrome
- Angina
- Arthritis
- Cervical adenitis
- Cervical spine affection
- Dental caries
- Ear, nose, throat (ENT) deep-space infection
- Esophagitis
- Laryngitis
- Lymphadenitis
- Mastoiditis
- Metastatic tumor
- Mumps
- Parotiditis
- Pahryngitis
- Post-tonsillectomy/adnoidectomy
- Retropharyngeal abscess
- Rhinitis
- Sialoadenitis
- Sinusitis
- Syphilitic meningitis
- Tooth infection
- Temporomandibular Joint Dysfunction (TMJ)
- Tonsilitis
- Trigeminal Neuralgia [1] [1]
Primary otalgia
Ear pain can be caused by disease in the external, middle, or inner ear, but the three are indistinguishable in terms of the pain experienced.
External ear pain may be:
- Mechanical: trauma, foreign bodies such as hairs, insects or cotton buds.
- Infective (otitis externa): Staphylococcus, Pseudomonas, Candida, herpes zoster, or viral myringitis. (See Otitis externa)
Middle ear pain may be:
- Mechanical: barotrauma (often iatrogenic), Eustachian tube obstruction leading to acute otitis media.
- Inflammatory / infective: acute otitis media, mastoiditis.
Secondary otalgia
Ear pain can be referred pain to the ears in five main ways:
- Via Trigeminal nerve [cranial nerve V]. Rarely, trigeminal neuralgia can cause otalgia.
- Via Facial nerve [cranial nerve VII]. This can come from the teeth (most commonly the upper molars, when it will be worse when drinking cold fluids), the temporomandibular joint (due to its close relation to the ear canal), or the parotid gland.
- Via Glossopharyngeal nerve [cranial nerve IX]. This comes from the oropharynx, and can be due to pharyngitis or tonsillitis, or to carcinoma of the posterior third of the tongue.
- Via Vagus nerve [cranial nerve X]. This comes from the laryngopharynx in carcinoma of the pyriform fossa or from the esophagus in GERD.
- Via the second and third cervical vertebrae, C2 and C3. This ear pain is therefore postural.
Psychogenic otalgia is when no cause to the pain in ears can be found, suggesting a functional origin. The patient in such cases should be kept under observation with periodic re-evaluation.
Diagnosis
It is normally possible to establish the cause of ear pain based on the history. It is important to exclude cancer where appropriate, particularly with unilateral otalgia in an adult who uses tobacco or alcohol.[1]
Laboratory Findings
- Complete blood count (CBC)
- Culture of otorrhea
MRI and CT
- Head CT scan
Other Diagnostic Studies
- Tympanometry
- Audiometry
Treatment
- Warm compress
- Physical therapy, dental bite adjustment (TMJ)
- Remove foreign bodies with a curette
Pharmacotherapy
Acute Pharmacotherapies
- Control pain with acetaminophen, nonsteriodal anti-inflammatory drugs (NSAIDs), and topical benzocaine solution
- Antibiotics (otitis media, otitis externa, pharyngitis / tonsillitis)
- NSAIDs for TMJ
- Steroid drops, 8% aluminum acetate +/- 2% acetic acid (otitis externa)
- Antistaphylococcal antibiotics, IV antipseudomonal (malignant otitis externa)
- Decongestants (barotrauma)
See also
External links
- What to do if your child has earache from Seattle Children's Hospital
- Earaches - Causes, Considerations, Home Care and Prevention from Healthbasis.com
References
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
