Otalgia

Pain in the ear can be due to problems occurring locally
in the ear or referred to it from remote areas.
A. Local Causes
1. External ear. Furuncle, impac ted wax, otitis
externa, otomycosis , myringitis bullosa, herpes zoster,
and malignant neoplasms.
2. Middle ear. Acute otitis media, eustachian tube
obstruction, mastoiditis, extradural abscess, aero-otitis
media, and carcinoma middle ear.
B. Referred Causes
As ear receives nerve supply from Vth (auriculotemporal
br), lXth (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
1. Via Vth cranial nerve
(a) Dental. Caries tooth, apical abscess, impacted
. olar, malocclusion.
(b) Oral cavity. Benign or malignant ulcerative lesions
in the oral cavity or tongue.
(c) Temporomandibular joint disorders. Bruxism,
osteoarthritis, recurrent dislocation, ill-fitting denture.
(d) Sphenopalatine neuralgia.
2. Via IXth cranial nerve
(a) Oropharynx. Acute tonsillitis, peritonsillar abscess,
tonSillectomy. Benign or malignant ulcers of soft palate,
tonsil and its pillars.
(b) Base of tongue. Tuberculos is or malignancy.
(c) Elongated styloid process.
3. Via Xth cranial nerve. Malignancy or ulcerative
lesion of: vallecula, epiglottis, larynx or laryngopharynx,
oesophagus.
4. Via C2 and C3 spinal nerves. Cervical spondylosis,
injuries of cervical spine, caries spine.
C. Psychogenic Causes
When no cause has been discovered, pain may be fu nctional
in origin but the patient should be kept under
observation with period iC re-evaluation .
Otalgia is a symptom. It is essential to find its cause
before specific treatment can be instituted.