Understanding Otalgia: Causes, Diagnosis, and Treatment | Ear Pain Explained

What is Otalgia?

Otalgia is a medical term for  ear pain. Ear pain can be a sharp, dull, or burning pain in one or both ears and it  may last a short time or be ongoing.

It is classified as:

  • Primary Otalgia- pain that originates due to  a disease within the ear.
  • Referred or Secondary Otalgia- is the pain that originates by a disease outside the ear.

What are the causes of Primary Otalgia?

It can be caused due to abnormalities in the external ear, middle ear or inner ear.

PINNA:

  • Trauma (tears, laceration)
  • Hematoma- localised collection of blood due to trauma
  • Perichondritis- infection of ear cartilage
  • Frost bite or sunburn
  • Tumour

External auditory canal:

  • Impacted ear wax- Excessive, hardened wax in ear canal
  • Foreign body (cotton, insects)
  • Furunculosis- infection of hair follicle in ear canal [Boil]

Otitis externa- diffuse infection and inflammation of ear canal skin

  • Hesrpes Zoster Otiticus- Viral infection
  • Otomycosis- fungal infection of ear canal
  • tumour

MIDDLE EAR:

  • Acute Otitis Media- acute infection of middle ear by bacteria
  • Secretory Otitis Media- fluid collection in middle ear due to eustachian tube dysfunction
  • Chronic Otitis Media
  • Otitic Barotrauma- occurs due to middle ear pressure changes (common during airplane travel)
  • Traumatic Perforation- rupture of ear drum 
  • Hemotympanum- collection of blood in middle ear
  • Neoplasm

Mastoid: 

  • Mastoiditis- infection of mastoid air cell behind the ear
  • Mastoid Abscess[ pus collection behind the ear]
  • Neoplasm

INNER EAR:

  • Noise- excessive noise cause inner ear injury 
  • Neoplasm

What are the causes of Referred Otalgia?

 Ear pain is labelled as referred otalgia when the ear examination is normal (no abnormalities in the ear). Causes for referred otalgia are:

  • Dental causes- caries, abscess, impacted tooth
  • Oral cavity – ulcers, infection
  • TMJ joint ( Temporo Mandibular Joint) dysfunction – joint near the front of the ear
  • Tonsillitis and pharyngitis
  • Nose: sinusitis, neoplasm
  • Elongated styloid process- Eagles syndrome
  • Trigeminal neuralgia
  • Glosssopharyngeal neuralgia
  • Foreign body or tumor in the throat 
  • Cervical spondylosis

What are the risk factors?

  • Insertion of unclean/ sharp articles into the ear
  • Instillation of contaminated solution
  • Swimming in polluted water
  • Upper respiratory tract infections
  • Eustachian tube dysfunction
  • Allergy

How is it diagnosed?

Diagnosing ear pain often only requires a medical history and physical examination. Imaging and blood tests are less commonly needed.

Medical History

Doctor will ask questions related to the details of your pain:

  • What does the pain feel like?
  • Does the pain come and go or is it constant?
  • Are there any associated symptoms present, such as fever, hearing loss, balance problems or dizziness, ear drainage, or 
  • tinnitus 26 (ringing in the ears)?
  • Have you recently been ill or experienced any trauma to the face or ear?
  • Physical Examination- detailed examination of ear, nose and throat
  • Endoscopic examination
    • Balance assessment and Hearing test (Audiometry)- depending on associated symptoms like hearing loss, giddiness
  • Imaging- X-ray, CT scan and MRI scan

What is the treatment for ear pain?

The underlying cause for ear pain must be identified. Various treatment options are available:

  • Oral Medications: painkillers and antibiotics, treatment of cold
  • Ear drops/ Ear cleaning/ Ear packing
  • Surgery can be considered in special instances like:
    • Severe infection of middle ear and mastoid
    • Ear drum perforation
    • Fluid in middle ear
    • Tumors or neoplasms

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