ENTtoday
  • Home
  • COVID-19
  • Practice Focus
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Departments
    • Issue Archive
    • TRIO Best Practices
      • Allergy
      • Facial Plastic/Reconstructive
      • Head and Neck
      • Laryngology
      • Otology/Neurotology
      • Pediatric
      • Rhinology
      • Sleep Medicine
    • Career Development
    • Case of the Month
    • Everyday Ethics
    • Health Policy
    • Legal Matters
    • Letter From the Editor
    • Medical Education
    • Online Exclusives
    • Practice Management
    • Resident Focus
    • Rx: Wellness
    • Special Reports
    • Tech Talk
    • Viewpoint
    • What’s Your O.R. Playlist?
  • Literature Reviews
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Events
    • Featured Events
    • TRIO Meetings
  • Contact Us
    • About Us
    • Editorial Board
    • Triological Society
    • Advertising Staff
    • Subscribe
  • Advertise
    • Place an Ad
    • Classifieds
    • Rate Card
  • Search

‘Doctor, My Ear Hurts’: Diagnosing Referred Otalgia

by Sheri J. Polley • April 1, 2008

  • Tweet
  • Email
Print-Friendly Version
Gerard Gianoli, MD

You Might Also Like

No related posts.

Explore This Issue
April 2008
Gerard Gianoli, MD

Otalgia is a common complaint of patients presenting to both general practice and otolaryngology clinics. In some cases, ear pain is classified as primary otalgia, or pain that originates as the result of pathology within the ear itself. Examples of primary otalgia include external otitis, otitis media, mastoiditis, and auricular infections. Diagnosis of these conditions is fairly straightforward, and standard treatment generally alleviates the problem. However, in up to 50% of adults complaining of ear pain, the pain is the result of referred otalgia arising from non-otological disease.1 Physicians need to keep in mind the unique and complex innervation of the ear and be familiar with the myriad conditions that can result in ear pain in order to accurately diagnosis and treat the source of referred otalgia.

Figure. This flowchart describes the procedure for diagnosing and treating referred otalgia.

click for large version
Figure. This flowchart describes the procedure for diagnosing and treating referred otalgia.

Referred Otalgia

The sensory innervation of the ear involves six nerves: two branches of the cervical plexus, derived from the second and third cervical roots, and four cranial nerves-trigeminal (V), facial (VII), glossopharyngeal (IX), and vagus (X).1 Noxious stimulation of any branch of these nerves by any of the structures receiving sensory input from these nerves can cause ear pain. This complex innervation can make diagnosis of the etiology of ear pain in the absence of primary ear pathology a challenge.

Because referred otalgia can be the result of a vast number of problems ranging from dental issues (e.g., temporomandibular disease) to a more serious condition requiring immediate diagnosis and intervention (e.g., hidden malignancy), the physician must use a structured, systematic approach to identify the etiology of the patient’s pain. A comprehensive history and exhaustive physical examination are crucial components of this approach. The findings of the history and physical examination will determine what interventions or additional testing may be indicated (see flowchart).

History

The physician must obtain a complete history regarding the patient’s chief complaint of ear pain. Ask the patient to describe his or her pain: onset, characteristics, severity, localization, radiation. Does anything done by the patient seem to alleviate or exacerbate the pain? It is important to remember that the severity of pain is not in any way indicative of the seriousness of pathology.

The physician should then question the patient regarding associated symptoms. For example: Does the patient suffer from tinnitus, hearing loss, vertigo, sinusitis, facial pain, myalgias, neuralgias, or arthritis?

Pages: 1 2 3 4 | Single Page

Filed Under: Departments, Medical Education, Otology/Neurotology, Practice Focus Tagged With: CT, diagnosis, nerves, otalgia, otitis media, pain, PET, research, treatmentIssue: April 2008

You Might Also Like:

The Triological SocietyENTtoday is a publication of The Triological Society.

The Laryngoscope
Ensure you have all the latest research at your fingertips; Subscribe to The Laryngoscope today!

Laryngoscope Investigative Otolaryngology
Open access journal in otolaryngology – head and neck surgery is currently accepting submissions.

Classifieds

View the classified ads »

TRIO Best Practices

View the TRIO Best Practices »

Top Articles for Residents

  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Why More MDs, Medical Residents Are Choosing to Pursue Additional Academic Degrees
  • What Physicians Need to Know about Investing Before Hiring a Financial Advisor
  • Tips to Help You Regain Your Sense of Self
  • Should USMLE Step 1 Change from Numeric Score to Pass/Fail?
  • Popular this Week
  • Most Popular
  • Most Recent
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Rating Laryngopharyngeal Reflux Severity: How Do Two Common Instruments Compare?
    • Vertigo in the Elderly: What Does It Mean?
    • Complications for When Physicians Change a Maiden Name
    • Neurogenic Cough Is Often a Diagnosis of Exclusion
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Rating Laryngopharyngeal Reflux Severity: How Do Two Common Instruments Compare?
    • Vertigo in the Elderly: What Does It Mean?
    • Neurogenic Cough Is Often a Diagnosis of Exclusion
    • Complications for When Physicians Change a Maiden Name
    • Smell and Taste Disorder Differences Seen Between Long-Term COVID-19 and non-COVID-19 Patients
    • The Triological Society is Growing in Ethnic and Gender Diversity as Well as Thesis Acceptance
    • No Persistent Postoperative Swallowing Dysfunction Following Pharyngeal Surgery in Patients with Obstructive Sleep Apnea
    • Do the Principles of Adult Learning Maximize Training Efficiency and Efficacy for Pediatric Otolaryngologists?
    • Prolonged Operative Time Associated with Multiple Adverse Outcomes in Endoscopic Sinonasal Surgery

Polls

Do you think that women have made large enough strides in otolaryngology leadership and gender equity?

View Results

Loading ... Loading ...
  • Polls Archive
  • Home
  • Contact Us
  • Advertise
  • Privacy Policy
  • Terms of Use
  • Cookie Preferences

Visit: The Triological Society • The Laryngoscope • Laryngoscope Investigative Otolaryngology

Wiley
© 2023 The Triological Society. All Rights Reserved.
ISSN 1559-4939