Causes of Otalgia

Local Causes
Causes of Referred Pain
Acute otitis externa
Children;
Acute otitis media
Tonsillitis
Furunculosis
Dental disease / teething
Barotrauma
Upper respiratory tract infection
Ramsay Hunt Syndrome
Adults;
Neoplasia
Dental disease
Perichondritis
Temporomandibular joint disease; arthritis, OA or RA
Myringitis
Upper respiratory tract infection
Sinisitis
Spasm of muscles of mastication
Cervical spondylosis
Upper airway neoplasia
Pharyngeal neoplasia
Cervical nerves, trigeminal, glossopharyngeal and vagal nerves are involved in referred pain to the ear. Mechanism of referred
otalgia; C-spine
-> cervical nerves 2 & 3
Nose and sinuses
-> CN V
Teeth
-> CN V
Temporomandibular joint
-> CN V
Oropharynx
-> CN IX
Larynx
-> CN X
Oesophagus
-> CN X
1)
Acute otitis externa;
a.
Common associations with eczema
b.
Common after use of cotton buds
c.
Common in anything that increases humidity in the ear ear phone use, swimming etc.
d.
4 main causative agents; streptococcus, staphylococcus, pseudomonas and fungus (secondary fungal infection is
common after initial overuse of antibiotics)
e.
Sx; itching and pain
f.
O/E;
i.
Red and tender ear canal
ii.
Watery discharge
iii.
Accumulation of debris + oedema hearing loss
g.
Rx;
i.
Topical antibiotic OR
ii.
Topical steroid drop OR
iii.
Antibiotic dressing (if canal severely swollen)
iv. 1% hydrocortisone (for itching)
2)
Acute otitis media;
a.
Causes severe otalgia
b.
Upper respiratory tract infection ascends via and blocks Eustachian tube negative pressure in middle
ear exudates otitis media with effusion (OME)
c.
N.B Mastoiditis is a severe possible complication
d.
Sx;
i.
Pain (due to pressure in middle ear)
ii.
Hearing loss
iii.
Disharge (if tympanic membrane ruptures) reduced pain
iv. Imbalance (especially in adults)
e.
O/E;
i.
Injected, congested and bulging ear drum
ii.
Hearing loss
iii.
Large tonsils ( + adenoids NB cannot see on normal examination of buccal cavity and pharynx)
iv. Tympanometry shows no ear movement and produces a flat trace. (Tympanometry measures how
the tympanic membrane moves in relation to an applied pressure and thus pressures in the middle ear can be
calculated)
f.
Rx;
i.
NSAIDs and analgesics
ii.
Systemic broad spectrum antibiotics
iii.
Decongenstants
iv. Myringotomy and grommet insertion (if recurrent)
v. Adenoidectomy (if recurrent)
3)
Ramsay Hunt Syndrome;
a.
Infection of the facial nerve ganglion by herpes zoster (shingles)
b.
NB can cause permanent damage to facial nerve if not treated promptly
c.
Sx;
i.
Otalgia
ii.
Facial palsy
iii.
Hearing loss
iv. Imbalance
d.
O/E;
i.
Vesicles in ear canal and around pinna
e.
Rx;
i.
Systemic acyclovir