Ear, Nose, and Throat – Otalgia (Ear Pain): By Russell Hollins M.D.

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Ear, Nose, and Throat – Otalgia (Ear Pain)
Whiteboard Animation Transcript
with Russell Hollins, MD
https://medskl.com/Module/Index/otalgia


Otalgia, or ear pain, is a complex diagnostic challenge due to the numerous local conditions that can trigger it, as well as the multitude of near and distant sites that can refer pain to the ear. The way I approach ear pain is to classify it as arising from the external ear, from the middle ear, or from distant sites causing referred pain.

Here are some common causes of pain under each heading that you should always consider:

Pain arising in the external ear can be due to an infection, such as otitis externa or herpes simplex/zoster infection. Trauma to the external ear from burns or frostbite can also cause external ear pain. Finally, keep in mind the possibility of a foreign body impaction (such as a Q-tip) or carcinoma of the external canal.

Middle ear pain is most commonly due to acute otitis media. Think of this in a patient with fever, ear pain, and a bulging tympanic membrane on otoscopic examination.

Mastoiditis can also cause ear middle ear pain. Consider this in a patient with fever, lethargy, and tenderness and redness behind the ear with possible drainage. These patients should be referred to an ENT service for assessment and immediate treatment to prevent complications.

Pain to the ear can also be referred from other structures in the head and neck. If no pathology is found on ear exam, complete a thorough head and neck exam to identify a source of the pain. Common causes of referred pain include TMJ disorders, dental pain, cervical pain, migraine, and trigeminal neuralgia.

Always complete a thorough history and examination of the ear and of the head and neck on a patient presenting with ear pain. Patients with pain not responding to medication or with complications of ear pathology should be referred to an ENT specialist for further investigation and management.