Ear Pain (Otalgia)

Otalgia or ear pain may be referred to as a primary with the source being the ear or it may be called as secondary – which is referred to the ear with or without signs or symptoms of the primary source of the pain. In about 50% or more patients who complain otalgia, the pain emanates from a source other than the ear.

The Primary Causes of Ear Pain

• Otitis externa (bacterial or fungal infections)
• Myringitis (Tympanic membrane infection)
• Wax impaction
• Foreign body in the ear canal
• Perichondritis or chondritis of the auricle (Pinna Infection )
• Carbuncle or furuncle (Boil)
• Frostbite or burn of pinna
• Trauma to the external canal
• Traumatic perforation of the tympanic membrane
• Herpes simplex virus infection
• Herpes zoster oticus
• Eustachian tube dysfunction
• Eustachian tube obstruction
• Otitis media and mastoiditis, which may be complicated
• Venous sinus thrombosis
• Brain abscess
• External canal, middle ear, or skull base neoplasms including metastatic disease

Causes of Referred Pain in the Ear

Orofacial region

• Temporomandibular joint disorder
• Exposed tooth root surfaces
• Periodontal infection (superficial or deep)
• Unerupted or impacted teeth
• Traumatic occlusion
• Ill-fitting dental appliance
• The recent adjustment of archwires (orthodontic therapy)
• Primary or recurrent herpes simplex virus infection
• Acute herpes zoster
• Mucocutaneous disorders (i.e., lichen planus)
• Geographic tongue
• Burning mouth or burning tongue
• Sinusitis
• Nasal infections
• Parotid gland infection

The Pharynx

• An inflammatory disorder involving the hypo-oro-nasopharynx
• Tonsillitis and peritonsillar abscess
• Post-tonsillectomy pain
• Eagle syndrome

The Larynx and oesophagus

• Laryngitis
• Perichondritis or chondritis
• Arthritis of cricoarytenoid joint
• Hiatal hernia
• Gastroesophageal reflux
• Infection or foreign body in esophagus

Other sources

• Traction or inflammation involving cerebrovascular blood supply (carotidynia)
• Thyroiditis
• Angina

Neurologic Disorders

• Continuous neuropathic pain
• Episodic neuropathic (neuralgic) pain
  – Trigeminal neuralgia
  – Glossopharyngeal neuralgia
  – Nervus intermedius (geniculate) neuralgia
  – Occipital neuralgia
  – Vagal and superior laryngeal neuralgia

Headaches

• Primary headaches
  – Tension-type headache now including cervical myalgia
  – Chronic paroxysmal hemicranias
  – Giant cell arteritis (Temporal arteritis)
• Secondary headaches
  Headache or facial pain attributed to disorders of the cranium,
  neck, eyes, ears, nose, sinuses, teeth, mouth, or
  other facial or cranial structures

Neoplastic Disease

• Carcinoma, sarcomas (including Hodgkin’s and non-Hodgkin’s lymphomas), and metastatic disease

Due to a wide and vast range of causes of ear pain, patients should not treat ear pain themselves at home. Kindly see your ENT doctor to find the real cause of your ear pain. Accurate diagnosis of your ear pain helps in knowing the cause and providing apt treatment (targeted treatment aiming at relieving pain).