Pain in the ear can be due to problems occurring locally in the ear or referred to it from remote areas.
1. LOCAL CAUSES
External ear : Furuncle, impacted wax, otitis externa, otomycosis, myringitis bullosa, herpes zoster, and malignant neoplasms.
Middle ear : Acute otitis media, eustachian tube obstruction, mastoiditis, extradural abscess, aero-otitis media, and carcinoma middle ear.
2. REFERRED CAUSES
As ear receives nerve supply from Vth (auriculotemporal br.), IXth (tympanic br) and Xth (auricular br.) cranial nerves; and from C2 (lesser occipital) and C2 and C3 (greater auricular), pain may be referred from these remote areas.
Via Vth cranial nerve :
□ Dental. Caries tooth, apical abscess, impacted molar, malocclusion.
□ Oral cavity. Benign or malignant ulcerative lesions of oral cavity or tongue.
□ Temporomandibular joint disorders. Bruxism, osteoarthritis, recurrent dislocation, ill-fitting denture.
□ Sphenopalatine neuralgia. Via IXth cranial nerve :
□ Oropharynx. Acute tonsillitis, peritonsillar abscess, tonsillectomy. Benign or malignant ulcers of soft palate, tonsil and its pillars.
□ Base of tongue. Tuberculosis or malignancy.
□ Elongated styloid process.
Via Xth cranial nerve : Malignancy or ulcerative lesion of: vallecula, epiglottis, larynx or laryngopharynx, oesophagus.
Via C2 and C3 spinal nerves : Cervical spondylosis, injuries of cervical spine, caries spine.
3. PSYCHOGENIC
When no cause has been discovered, pain may be functional in origin but the patient should be kept under observation with periodic re-evaluation.
Otalgia is a symptom. It is essential to find its cause before specific treatment can be instituted.