Otalgia

What is otalgia?

Otalgia is aching or pain in the ear and causes can be primary, relating to the ear itself, or referred from sources outside the ear.

Otalgia is very common, especially in children, and most cases are transient.¹

• History - especially pertaining to onset, and precipitating factors - eg, noise, duration, discharge, fever, swallowing disorder, dental history.

• Examination - otoscopy looking for causes - eg, otitis media, cerumen.

• If otoscopy is unremarkable, consider referred causes of pain and examine the cranial nerves, especially V, VII, IX and X.

• Also examine - the nose, sinuses, oropharynx and nasopharynx (occult carcinoma often presents with otalgia), cervical lymph nodes, TMJ, parotid glands, larynx, and trachea.

• Check temperature.

• Investigations depend on the suspicion from the history and examination - the following can be performed: FBC, TFTs, ESR, CXR and audiogram.

Always consider neoplastic causes, both in children and in adults with persistent otalgia. Other red flags include weight loss, voice change, lymphadenopathy and dysphagia.

• Analgesia.

• Treat the underlying cause.

• If no cause is found, consider re-reviewing the patient in a few days.

• If pain continues and still the cause is unclear, consider a specialist referral to exclude a sinister cause of otalgia.

Almost 50% of patients will have spontaneous resolution of otalgia with no underlying cause detectable.²