Ear pain, or otalgia, can originate from diseases within the ear itself or from diseases in surrounding areas that cause referred pain. Referred otalgia is a common presentation and can be caused by conditions of the teeth, jaw, throat, neck muscles, or cancers of the throat or neck. A thorough history, physical exam, and diagnostic tests are needed to identify the underlying source of the ear pain.

2. • Defined as ear pain
or
an earache

3. or Primary otalgia:
is the pain that originates by a
disease within the ear.
or secondary otalgia: is
the pain that originates by a
disease outside the ear.

4. • Richly innervated
• Multiple cranial & spinal nerves
• Shared nerve supply with other head &
neck sites
• Inner ear has no sensory supply

9. Pinna
• Trauma (Laceration &
bites ,tears )
• Hematoma
• Perichondritis
• Infected pre-auricular
sinus
• Frostbite, sunburn
• Neoplasm
External auditory canal
• Impacted wax
• Foreign body
• Keratosis obturans
• Otitis externa
• Malignant otitis externa
• Herpes zoster oticus
• Exostoses
• Neoplasm

10. Middle Ear
• Bullous myringitis
• Acute otitis media
• Secretory otitis media
• Traumatic perforation
• Hemotympanum
• Otitic barotrauma
• Neoplasm
Mastoid
• Mastoiditis
• Mastoid abscess
• Granulomas
• Neoplasm
Inner ear
• Acoustic trauma
• Noise
• Meniere’s disease
• Vestibular schwannoma

11.  Normal secretion of
cerumenous and
sebaceous glands
 Excessive secretion,
narrowing of EAC ,stiff
hairs can lead to impaction
 Pain, deafness, tinnitus,
 Removal

12. • Insect or small objects
• Commonly occurs in children
• Foreign body visible on otoscopic examination
• Treated by removal
• Removal may need sedation

14.  Staphylococcal Infection of hair follicle of Ext Meatus
 Clinical Features
 Painful swelling in outer 1/3rd of ext auditory canal
 Discomfort aggravated on movement of jaw ,and pinna
 Deafness
 Treatment
 Ear pack of 10% ichthammol glycerin
 systemic antibiotics
 Analgesics
 If abscess formed ,incision and drainage should be done
 Blood Sugar Levels

16.  Diffuse inflammation of meatal skin
 Etiology
 Hot humid climate
 Swimmers
 Trauma
 Unskilled instrumentation
 Scratching ear canal with hair pin
 Excessive cleaning of ear canal after swimming
 Existing CSOM
 Causative Organisms
 Pseudomonas aeruginosa
 Staph.aureus
 B.proteus

17.  Clinical features
 Hot burning sensation
 Pain
 Serous or purulent discharge
 Meatal skin is red ,swollen and tender
 Cheesy debris in the deep meatus
 pain elicited by traction of auricle or pressure on tragus
 Treatment
 Aural toilet
 Medicated wicks
 Systemic and Topical antibiotics with steroids
 Analgesics

19.  Progressive infection of meatus, surrounding
soft tissue and skull base
 Causative Organism
 Pseudomonas auroginosa
 Predisposing Factors
 Elderly diabetics
 Immunocompromised

20.  Clinical Features
 Excruciating Pain
 Granulations in the Ext ear canal
 XII nerve palsy
 Treatment
 High doses I/V Antibiotics for
6-8 weeks
 Diabetic control
 Debridement of devitalized
tissue & bone

21.  Viral Infection affecting geniculate
ganglion of facial nerve
 Clinical Features
 Severe otalgia
 Vesicular rash on the in pinna or external
auditory canal
 VII Nerve Palsy (Ramsay Hunt Synd.)
 Treatment
 Oral acyclovir

23.  Fungal Infection of ear canal
 Aspergilus niger, Aspergilus fumigatus, Candida
albicans
 Predisposing Factors
 Hot & Humid climate
 Topical antibiotics drops for CSOM or otitis externa

24.  Clinical Features
 Itching
 pain
 Discharge with musty color
 On otoscopic examination ,filamentous growth
(black ,blue or green)or white creamy deposit
.
 Treatment
 Aural Toilet
 Antifungal Agents

26.  Acute Infection of middle ear by pyogenic organisms.
 Common in infants and children
 Bacteriology
 Strep.Pneumonae,H INF, Moraxella Catarrhalis
 Predisposing factors
 Any thing interfering with normal function of eustachian
tube
 Clinical Features
 Deafness ,pain ,Fever,Ear discharge
 Red Congested buldging TM
 Small Perforation with ear discharge

27.  Management
 Antibiotics
 Analgesics and Antipyretics
 Nasal Decongestants
 Systemic,Topical
 Ear Toilet
 Myringotomy
 Tm bulging and Pain Not responding to above
treatment

29.  Pain onset during descent of airplane or while
diving
 Non suppurative condition due to failure of
Eustachian tube to maintain middle ear pressure
at ambient atmospheric level
 Mechanism
 When atmospheric pressure is higher than middle ear
pressure Eustachian tube gets locked.- -ve pressure
in middle ear - retraction of tympanic membrane-
hyperaemia,transudation and haemorrhage in the
middle ear.

30. • Clinical features
• Severe earache ,hearing loss,tinnitus
• Tm retracted ,congested or ruptured
• Hemotympanum
 Treatment
 Nasal decongestants
 Antihistamines
 Myringotomy
 Prevention
 Swallow during descent
 Do not sleep during descent
 Auto inflation of tube by valsalva during descent.

31. • Painful condition occurring
spontaneously and
resolving within several
days .
• Vesicular eruption is seen
on the tympanic membrane
which maybe associated
with bleeding or serous
discharge .
• Probably caused by virus or
mycoplasma pneumonia

32.  Inflammation of mucosal lining of
antrum and mastoid air cell system.
 Follow acute suppurative otitis media
 Clinical Features:
 Pain behind the ear
 Fever
 Ear Discharge
 Mastoid tenderness
 Sagging of posterosuperior meatal
wall
 Swelling over the mastoid
 Deafness

33. Management :
 Hospitalization
 Antibiotics
 Myringotomy
 Pus under tension not resolving with medical therapy
 Cortical Mastoidectomy
 Subpreiosteal abscess
 Positive reservoir sign
 No change in symptoms after 48 hrs of medical management
 Complications
 Facial palsy, labrynthitis,intracranial complications.

34. is an unpleasant sensation localized to an
area separate from the site of the
causative injury or other noxious stimulus

35. Often, referred pain is caused by nerve
compression or irritation.
In this circumstance, the sensation of pain
will generally be felt in the territory that
the nerve serves (ie,somatic dermatome)
even though the damage originates
elsewhere (ie,visceral tissue).

36. • CLINICALLY NORMAL
Pinna
External auditory meatus
Tympanic membrane
Mastoid process

37. Referred earache may be a presenting
symptom of head and neck cancer

38. Common causes :
• Dental causes(caries ,abscess ,impacted teeth)
• TMJ dysfunction
• Tonsillitis and pharyngitis
• Cervical spine arthritis

39. Uncommon cause :
• Tumors (hypopharynx ,larynx ,base of the
tongue ,nassopharynx ,parotid
,esophagus )
• Neuralgias (trigeminal ,glossopharyngeal
,geniculate )
• Temporal arteritis
• Oral ulcers
• Eagles syndrome

40. Uncommon cause :
• Sinusitis /Nasal polyps
• Thyroiditis
• Parotid gland disorders(mumps ,stone )
• GERD
• Myocardial ischemia
• Psychogenic otalgia

41. Ear pain can be referred to the ears
in five main ways.

43. Caused by :
(joint dislocation ,arthritis )
clinical features :
pain around the TMJ
Trismus
Joint sound or crepitus
Tenderness of the joint or associated muscle
Management :
Rest
Soft diet
Moist heat and massage
NSAIDS
Muscle relaxant
Consultation with oral surgeon

44. Caries tooth
Apical abscess
Impacted molar
Malocclusion

45. –Recurrent aphthous ulcer is commonest
oral ulcer
–Other causes include trauma ,nutritional
deficiency ,Behcets syndrome and
autoimmune disorders
–Painful locally ,earache

47. • Tonsillitis is one of the commonest cause of
referred otalgia .
• Post-tonsillectomy referred pain less severe in
children than adult .
• Peritonsiller ,retropharyngeal ,Parapharyngeal
abscess will cause earache too
• Sore throat ,fever ,trismus ,odynophagia are
associated symptoms with ear ache

49. • Parotid ,hypopharynx ,nassophayrynx ,base of
tongue ,larynx and cervical spine
• Risk factors include smoking ,alcohol use ,age
older than 50 years,radiation exposure
• Associated symptom ( hoarsness,
dysphagia,nasal blockage ,weight loss )

53. • Trigeminal ,glossopharyngeal and geniculate
(intermedius) neuralgia
• Pain usually brief (seconds) in their sensory
distribution area
• Severe, lancing ,electric – shock- like pain
• May have trigger point

54. • It is an elongation of the styloid process
• Cause deep ,unremitting pain exacerbated by
swallowing ,yawning ,foreign body sensation
in throat .
• Treated by surgical excision via trans-oral
approach or lateral approach .

56. • Cause crepitus or neck and ear pain with neck
movements
• Decreased neck range of motion ,tender
spinous processes or Para-spinal muscles
• Pain referred to ear from C2,C3 cervical nerve
root

57. when no cause to the pain in ears can be found,
it suggest a functional origin.
The patient in such cases should be kept under
observation with periodic re-evaluation.

58.  History
 Ear symptoms
 Nasal symptoms
 swallowing disorders
 recent trauma
 General Symptoms
 Examination
 General physical examination
 Complete ENT examination
 Rhinoscopy , nasopharyngoscopy , and indirect laryngoscopy.
 Palpation of the neck is important to look for thyroid disease and
1lymphadenopathy

59. • CBC ,ESR
• PTA
• TYMPANOMETRY
• Pneumatic otoscopy
• X- ray
• FIBEROPTIC NASOPHARYNGOSCOP
• Barium swallow
• Indirect laryngoscopy
• CT scan
• MRI with gadolinium
• Biopsy
• Diagnostic anesthetic blocks and pharyngeal cocainization