Ear ache and its various causes. Neuroanatomy and Approach towards the management in a nut shell.

1. 0TALGIA(EAR ACHE)
DR MANUPRITA SHARMA
M.S ENT.
ALLERGOLOGIST

2. LAYOUT
• DEFINATION
• TYPES
• NEUROANATOMY
• PATHOPHYSIOLOGY
• ETIOLOGY
• APPROACH TOWARDS MANAGEMENT
• TAKE HOME MESSAGE

3. DEFINATION
• PAIN IN OR AROUND THE EAR(SCOTT-
BROWN)

4. TYPES
1. PRIMARY (LOCAL) – pain arising from
diseases of the ear. Usually infection in origin.
2. SECONDARY OTALGIA(REFERRED)- non
otologic causes. Approx 50 % of opd visits.
Need is to identify the source of pain.
3. PSYCHOGENIC-when no cause discovered.
Patient should be kept under observation.

5. NEUROANATOMY
Sensory innervation of the ear and
referred pain
- The ear receives a cutaneous innervation
through
• four cranial nerves: trigeminal (V), facial (VII),
glossopharyngeal (IX)
• vagus (X)
• two branches of the cervical plexus: lesser
occipital nerve(C3), and great
• auricular nerve(C2+C3)

8. •

10. ETIOLOGY
A. LOCAL CAUSES:
1 . EXTERNAL EAR –
a . Furuncle
b. Impacted wax
c. Otitis externa
d. Otomycosis
e. Myringitis bullosa
f. Herpes zoster
g. Malignant neoplasms.

11. 2. MIDDLE EAR –
a. Acute otitis media
b. Eustachian tube obstruction
c. Mastoiditis
d. Extradural abscess
e. Aero-otitis media
f. Carcinoma middle ear

12. B. REFERRED CAUSES:
1. Via Vth cranial nerve-
a. Dental –
 Caries tooth
 Apical abscess
 Impacted molar
 Malocclusion.
b. Oral cavity -
Benign or maligant ulcerative lesions.

13. c. Temporomandibular joint disorders –
o Bruxism
oOsteoarthritis
oRecurrent dislocation
oIll fitting dentures
d. Sphenopalatine neuralgia.

14. • 2. Via IXth cranial nerve –
a. Oropharyx –
 Acute tonsillitis
 Peritonsillar abscess
 Tonsillectomy
 Ulcers of soft palate,tonsil,pillars.
b. Base of tongue- tuberculosis or malignancy.
c. Styalgia ( elongated styloid process)

15. • 3. Via Xth cranial nerve –
Malignancy or ulcerative lesion of vallecula,
epiglottis, larynx or laryngopharynx,
oesophagus.
4. Via C2 and C3 spinal nerves –
Cervical spondylitis
Injuries of cervical spine
Caries spine.

16. • Irritation of the trigeminal nerve (cranial nerve
V) is the most common cause of referred ear
pain.[3]

18. APPROACH TOWARDS MANAGEMENT

24. TAKE HOME MESSAGE
• OTALGIA is a symptom.
• It is not always associated with ear disease.
• It is essential to find its cause before specific
treatment can be instituted.
• TREAT THE CAUSE.

25. THANKYOU