Otalgia

Otalgia
ICD-10	H60 Otitis Externa H65&H66 Otitis Media H92 Otalgia
ICD-9	380.1 Otitis Externa 381 Otitis Media 388.7 Otalgia
DiseasesDB	18027

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]

Synonyms and keywords: ear pain, earache

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:

1. Otitis media (infection/inflammation of the inner ear). In Otitis media, most cases are viral in origin.
2. 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

(By organ system)

Cardiovascular	Acute Coronary Syndrome, Angina
Chemical / poisoning	No underlying causes
Dermatologic	Eczema, Psoriasis, Furunculosis
Drug Side Effect	Reaction to topical agents, Vinflunine, Deferasirox, Ciclesonide, Butorphanol
Ear Nose Throat	Acute otitis externa (Swimmer's ear), Acute otitis media, Auricular perichondritis, Cerumen impaction, Cholesteatoma, Chronic otitis externa, Ear canal foreign body, Eustachian tube dysfunction, Eustachian tube syringitis, Furunculosis, Herpes Zoster Oticus, Laryngitis, Malignant otitis externa, Mastoiditis, Myringitis bullosa, Pahryngitis, Retropharyngeal abscess, Rhinitis, Ruptured or perforated eardrum, Sinusitis, Sterile middle ear effusion, Tonsilitis, Tympanostomy tube obstruction, Acoustic neuroma, Ear Trauma, Suppurative otitis media
Endocrine	No underlying causes
Environmental	Ear Trauma, High altitude sickness, acute barotrauma
Gastroenterologic	Esophagitis
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	Bacterial: Auricular erysipelas, Cellulitis, Cervical adenitis, Cervical spine infection, Ear, nose, throat (ENT) deep-space infection, Syphilitic meningitis, Lymphadenitis, Parotiditis, Sialoadenitis, Furunculosis, Upper respiratory tract infection Viral: Mumps, Varicella, Lymphadenitis, Parotiditis, Sialoadenitis, Herpes Zoster Oticus, Myringitis bullosa, Ramsay Hunt syndrome
Musculoskeletal / Ortho	Cervical spine disease, Temporomandibular Joint Dysfunction (TMJ)
Neurologic	Trigeminal Neuralgia, Acoustic neuroma, Syphilitic meningitis, Arnold nerve cough syndrome, Glossopharyngeal neuralgia
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	Metastatic tumor, Ear tumor, Laryngeal carcinoma, Tongue cancer, Tonsil cancer
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	Functional disorders
Pulmonary	No underlying causes
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	Arthritis, Wegener granulomatosis
Sexual	No underlying causes
Trauma	Cerumen impaction, Cholesteatoma, Head injury, Perforated eardrum
Urologic	No underlying causes
Dental	Dental caries, Tooth infection
Miscellaneous	Post-tonsillectomy/adenoidectomy, Bell palsy, Chondrodermatitis nodularis chronica helicis, Keratosis obturans

In alphabetical order.

• 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
• Chondrodermatitis nodularis chronica helicis
• Ear canal foreign body
• Eczema
• Eustachian tube dysfunction
• Eustachian tube syringitis
• Furunculosis
• Herpes Zoster Oticus
• High altitude sickness
• Keratosis obturans
• Malignant otitis externa
• Mastoiditis
• Mumps
• Myringitis bullosa
• Other acute barotrauma
• Psoriasis
• Ramsay Hunt syndrome
• Reaction to topical agents
• perforated eardrum
• Sterile middle ear effusion
• Suppurative otitis media
• Trauma
• Tumor
• Tympanostomy tube obstruction
• Varicella
• Vinflunine

Referred Pain

• Acute Coronary Syndrome
• Angina
• Arnold nerve cough syndrome
• Arthritis
• Bell palsy
• Cervical adenitis
• Cervical spine affection
• Dental caries
• Ear, nose, throat (ENT) deep-space infection
• Esophagitis
• Functional disorders
• Glossopharyngeal neuralgia
• Laryngeal carcinoma
• Laryngitis
• Lymphadenitis
• Mastoiditis
• Metastatic tumor
• Mumps
• Pahryngitis
• Parotiditis
• Post-tonsillectomy/adenoidectomy
• Retropharyngeal abscess
• Rhinitis
• Sialoadenitis
• Sinusitis
• Syphilitic meningitis
• Temporomandibular Joint Dysfunction (TMJ)
• Tongue cancer
• Tonsilitis
• Tonsillar cancer
• Tooth infection
• Trigeminal Neuralgia
• Upper respiratory tract infection
• Wegener granulomatosis

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.

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

• Earwax

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