From the Guidelines
Otalgia, or ear pain, requires a thorough workup to identify the underlying cause before initiating treatment, with a focus on primary otalgia causes such as otitis externa, otitis media, or foreign bodies, and secondary otalgia causes including temporomandibular joint dysfunction, dental issues, or pharyngitis, as outlined in the clinical practice guideline for acute otitis externa 1. The workup for otalgia should begin with a detailed history and physical examination, focusing on the ear canal, tympanic membrane, and surrounding structures.
- Common causes of primary otalgia include:
- Otitis externa
- Otitis media
- Foreign bodies
- Treatment for acute otitis media typically involves amoxicillin 80-90 mg/kg/day divided twice daily for 5-10 days in children, or amoxicillin 500 mg three times daily for 5-7 days in adults, as supported by the clinical practice guideline for acute otitis externa 1.
- For otitis externa, topical antibiotic drops such as ciprofloxacin/dexamethasone (4 drops twice daily for 7 days) or ofloxacin (5-10 drops twice daily for 7 days) are effective, and pain management with acetaminophen (650 mg every 6 hours) or ibuprofen (400-600 mg every 6-8 hours) is appropriate for most cases, as recommended in the guideline for acute otitis externa 1.
- For secondary otalgia, treatment targets the primary source, which may include temporomandibular joint dysfunction, dental issues, or pharyngitis, and persistent or severe otalgia warrants further investigation with imaging studies like CT or MRI to rule out more serious conditions such as tumors or deep space infections. The importance of pain assessment and management in patients with otalgia is emphasized in the clinical practice guideline for acute otitis externa 1, highlighting the need for frequent use of appropriate analgesics at adequate doses to permit patients to achieve comfort, rest, and resume normal activities.
- Adequate pain control requires knowing the dose, timing, routes of delivery, and possible adverse effects of an analgesic, and convenience, ease of use, and cost make orally administered analgesics the preferred route of administration whenever possible.
- Nonpharmacologic therapies such as heat or cold, relaxation, and distraction are of unproven value, and opioids such as fentanyl citrate, morphine sulfate, and hydromorphone hydrochloride are indicated for procedure-related pain and moderate to severe around-the-clock pain, as outlined in the guideline for acute otitis externa 1.
From the Research
Diagnosis of Otalgia
The diagnosis of otalgia (ear pain) involves determining whether the pain is primary or secondary in origin. Primary otalgia originates from the ear itself, while secondary otalgia originates from outside the ear [ 2 ].
Common Causes of Otalgia
The common causes of primary otalgia include:
- Otitis media
- Otitis externa [ 2 ] The common causes of secondary otalgia include:
- Temporomandibular joint syndrome
- Dental infections [ 2 ]
- Dental and oral mucosal pathologies
- Temporomandibular joint disorders
- Cervical spine pathology
- Sinusitis
- Upper airway infection
- Reflux [ 3 ]
- Head and neck malignancy [ 3, 4, 5 ]
Assessment and Management
A thorough assessment of patients presenting with otalgia requires a detailed history and physical examination [ 2, 3, 6 ]. Directed studies such as imaging studies and consultation with specialists may be necessary if the diagnosis is not immediately clear [ 2 ].
Importance of Thorough Examination
A thorough physical examination of the ear and adjacent structures, including the teeth, is essential to determine the cause of otalgia [ 5 ]. Malignancies should be considered as a possible etiology of otalgia, especially in patients with risk factors such as smoking, alcohol use, and age 50 years or older [ 2 ].