DiseasesDB 18027 eMedicine ent/199 | MedlinePlus 003046 Patient UK Ear pain | |
ICD-10 H60 Otitis Externa H65&H66 Otitis Media H92 Otalgia ICD-9-CM 380.1 Otitis Externa
381 Otitis Media
388.7 Otalgia | ||
Ear pain, also known as otalgia or earache, is pain in the ear. Primary ear pain is pain that originates inside the ear. Referred ear pain is pain that originates from outside the ear.
Contents
Ear pain is not always associated with ear disease. It may be caused by several other conditions, such as impacted teeth, sinus disease, inflamed tonsils, infections in the nose and pharynx, throat cancer, and occasionally as a sensory aura that precedes a migraine.
Primary ear pain
Ear pain can be caused by disease in the external, middle, or inner ear, but the three are indistinguishable in terms of the pain experienced.
External ear pain may be:
Middle ear pain may be:
Referred pain
The neuroanatomic basis of referred earaches rests within one of five general neural pathways. The general ear region has a sensory innervation provided by four cranial nerves and two spinal segments. Hence, pathology in other "non-ear" parts of the body innervated by these neural pathways may refer pain to the ear. These general pathways are:
In an adult with chronic ear pain, yet a normal ear on exam, the diagnosis is carcinoma of the head and neck region until proven otherwise. Yet some patients will have a "psychogenic otalgia," and no cause as to the pain in ears can be found (suggesting a psychosomatic origin). The patient in such cases should be kept under observation with periodic re-evaluation.
Dental disease may cause pain in the region of the ear. E.g. dental caries causing pulpitis and/or periapical periodontitis (which may be associated with a periapical abscess) in a tooth can be referred via the auriculotemporal nerve (a branch of the trigeminal nerve), the tympanic nerve (a branch of the glossopharyngeal nerve) or via the auricular nerve (a branch of the vagus nerve). Temporomandibular joint dysfunction, impacted third molar teeth, and lesions of the floor of mouth or ventral surface of the tongue (underside of the tongue) are other possible causes of dental conditions which can cause ear pain.
Causes
Otitis media is a particularly common cause of otalgia in early childhood, often occurring secondary to other infectious illnesses, such as colds, coughs, or conjunctivitis.
Diagnosis
It is normally possible to establish the cause of ear pain based on the history. It is important to exclude cancer where appropriate, particularly with unilateral otalgia in an adult who uses tobacco or alcohol. Often migraines are caused by middle ear infections which can easily be treated with antibiotics. Often using a hot washcloth can temporarily relieve ear pain.
Management
Management of ear pain depends on the underlying cause.
Most cases of otitis media are self-limiting, resolving spontaneously without treatment within 3–5 days. Age-appropriate analgesics or a warm washcloth placed over the affected ear can help relieve pain until the infection has passed.
In some cases ear pain has been treated successfully with manual therapy.