Otalgia, or ear ache, can be caused by diseases of the ear itself (primary otalgia) or by non-ear related conditions that cause referred pain to the ear (secondary otalgia). The most common causes of primary otalgia are infections like acute otitis media, while dental issues, throat infections, and cervical spine problems frequently cause secondary otalgia by irritating the trigeminal, facial, or vagus nerves. It is important to determine whether the source of the ear pain is local to the ear or referred from another site before treating in order to address the underlying cause.

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