This document provides information about otalgia (ear pain), including its classification, etiology, symptoms, examination, investigations, and treatment. Otalgia can be primary, originating within the ear from inflammatory, traumatic or neoplastic conditions, or secondary, referred from areas innervated by nerves supplying the ear. Common causes include impacted earwax, otitis externa, acute otitis media, mastoiditis, dental issues, infections of the oral cavity, paranasal sinuses or oropharynx, and cervical spine problems. Evaluation involves inspection of the ear, ENT and dental exams, and potential imaging tests and endoscopy. Treatment focuses on identifying and addressing the underlying cause, with antibiotics

1. OTALGIA
Kaveri Koti
KA0115037

2. CONTENTS
● Introduction
● Classification
● Etiology
● Pathophysiology
● History
● Physical examination
● Investigations
● Treatment and management

3. INTRODUCTION
● Otalgia is defined as ear pain which may arise from the
auricle, the external meatus or the middle ear or mastoid or
it may be referred from other sources, depends on the
pathology.
● Pain may be lancinating(stabbing type) and paroxysmal,
severe or constant, deep and intermittent.
● Onset, duration, quality, localization and associated
symptoms gives a differential diagnosis for otalgia.

4. Classification
1. Primary otalgia - Pain originates within the ear and caused due
to inflammatory, traumatic and neoplastic conditions of the ear.
2. Secondary otalgia - Pain referred from head and neck regions,
which are innervated by the nerves that also supply to ear.

5. Etiology
Local causes -
1. External ear
Impacted wax

6. Otitis externa Otomycosis Myringitis bullosa

7. Foreign body
Malignant tumor

8. 2. Middle ear
Acute otitis media Eustachian tube
obstruction

9. Mastoiditis Barotrauma Extradural abscess

10. Referred causes-
1.Areas supplied by trigeminal nerve
● Dental-caries tooth, malocclusion, impacted molar
● Oral cavity-infection, trauma, malignant ulcers
● Salivery glands-parotid and submandibular inflammatory and
malignant diseases
● Periauricular lymphadenopathy - from scalp or neck
infections
● Nose and paranasal sinuses- trauma, infection, tumors etc
● TMJ disorders -bruxism, OA, recurrent dislocation, ill fitting
denture, malocclusion

11. 2. Area supplied by glossopharyngeal nerve
● Oropharynx- acute tonsillitis, peritonsillar abscess, post
tonsillectomy, benign and malignant ulcers of soft palate,
tonsil and base of tongue
● Eagle's syndrome - elongated styloid process
● Glossopharyngeal neuralgia
3. Area supplied by vagus nerve
● Malignancy or ulcerative lesions of- vallecula, larynx,
oesophagus, laryngopharynx
● Thyroiditis

12. 4. Area supplied by C2 and C3 spinal nerves
● Cervical arthritis, cervical spondylosis, caries spine, injuries
to cervical spine
5. Psychogenic causes
In such cases patient kept under observation and periodic
evaluation should be done

14. History of the patient

15. Associated ear symptoms
Otorrhea, hearing loss, ear fullness, swelling,
trauma, foreign body
Whether ear pain is associated with
Mastication, swallowing, voice change, purulent
rhinorrhea, etc.
Past history
Ear surgery

16. Physical examination
● Inspection of ear and otoscopy
● Palpation for tenderness
● ENT examination along with head and neck examination
● Dental examination
● Cranial nerve examination especially 5th,7th,9th,10th
● Assessment of cervical spine mobility / tenderness
● Palpation of TMJ and pterygoid muscles
● Oropharynx and laryngopharynx examination

17. Investigations
● Nasopharyngolaryngoscopy
● Esophagogram
● X-ray cervical spines
● Orthopantomogram(OPG)
● X-ray of TMJ and styloid process

18. Treatment and management
Treatment is based on etiology -
● Antibiotics
● Antivirals
● Antifungals
● NSAIDs etc
Management -
● Promotes healing - by ear irrigation and antibiotics
● Alleviate pain- by analgesics
● Restore normal function and remove foreign body

19. Surgical management -
Tympanoplasty
Ossiculoplasty
Myringotomy
Myringoplasty
Mastoidectomy etc based on pathology involved