Otalgia natural history

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Otalgia Microchapters


Patient Information





Differentiating otalgia from other diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis


History and Symptoms

Physical Examination

Laboratory Findings



Other Imaging Findings

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Medical Therapy



Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

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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]


Natural history, complications and prognosis depend on the disease process which is involving the ear. For most of the diseases the prognosis is good with good patient recovery.

Natural History

  • Otitis media: The symptoms of disease typically develop in the first five years of life. The course of the disease is benign with most of the patients recovering without any sequelae. If the otorrhea persists for more than 6-12 weeks chronic otitis media develops.
  • Otitis externa: The symptoms of disease typically develop in aquatic athletes. Disease course is benign but Chronic otitis externa develops if the disease process extends more than 6 weeks. Diabetic patients are at risk for development of Malignant otitis externa which is caused by Pseudomonas bacteria.
  • Mastoiditis: The symptoms of this disease typically develop in children younger than 2 years old with the median age being 12 months.
  • Cholesteatoma: The symptoms of this disease typically develop in adults. Progression of this disease causes destructive lesions in the ear and also hearing loss.


  • Cholesteatoma can be complicated by development of:
    • Erosion of the temporal bone
    • Brain dysfunction
    • Intra-cranial infections


  • Otitis media:
    • Prognosis is excellent.
    • Intra-cranial and intra-temporal complications occur in less than 1% patients.
    • Otitis media in infants younger than 12 months predisposes to long-term speech and language problems.
    • It has also been reported to negatively affect pre-existing cognitive or language problems warranting careful follow-up and early referral.
  • Mastoiditis:
    • Prognosis of Acute Mastoiditis is good as far as facial nerve, vestibule and intra-cranial structures are not involved. Recovery is complete from Surgical mastoiditis.
  • Cholesteatoma:
    • Prognosis is good with early recognition, timely surgical intervention and use of appropriate antibiotics. 90% patients have tympanic membrane perforation.


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