From the Guidelines
Otalgia (ear pain) in adults should be managed with a thorough history and physical examination to determine the cause, and treatment should be targeted at the underlying condition, with topical antibiotic drops being the first line of treatment for acute otitis externa, as they are the most effective treatment and may contain antibiotics, antiseptics, steroids, or a combination 1.
Diagnosis and Treatment Approach
When evaluating otalgia in adults, it is crucial to differentiate between primary and referred pain. Primary otalgia originates from the ear itself, while referred pain comes from other areas such as the temporomandibular joint, cervical spine, or dental issues. A thorough examination of these potential sources is essential for accurate diagnosis.
Primary Otalgia
For primary otalgia, common causes include otitis externa, otitis media, and foreign bodies.
- Otitis externa is typically treated with topical antibiotic drops, which are highly effective and can contain various combinations of antibiotics, antiseptics, and steroids 1.
- The choice of eardrop should be discussed with the patient, considering factors such as cost, dosing frequency, and the status of the eardrum 1.
- It is also important for patients to inform their doctor about any prior ear surgery, perforation of the eardrum, or recent use of other ear products to ensure the appropriate eardrop is selected 1.
Referred Otalgia
For referred otalgia, treatment targets the underlying cause. This may include:
- Temporomandibular joint dysfunction, managed with NSAIDs, muscle relaxants, and jaw exercises.
- Dental issues, which require a dental referral.
- Cervical spine pathology, treated with physical therapy and analgesics.
Symptomatic Relief
Symptomatic relief for all types of otalgia can include the use of acetaminophen or ibuprofen for pain management. Pain medicine is especially important in the first few days of treatment with eardrops, until the eardrops begin working, and patients should discuss with their doctor which pain medicines are best for them 1.
Follow-Up and Referral
If pain persists beyond 2 weeks despite treatment, or if accompanied by hearing loss, discharge, or neurological symptoms, referral to an otolaryngologist is warranted for further evaluation, which may include imaging studies like CT or MRI to rule out more serious conditions. Patients should notify their doctor if their pain or other symptoms fail to respond within the expected timeframe of 48 to 72 hours, as this may indicate a need for a change in treatment 1.
From the Research
Causes of Otalgia
- Primary otalgia is caused by conditions such as otitis media and otitis externa, which are more common in children 2, 3, 4
- Secondary otalgia is caused by conditions such as temporomandibular joint syndrome and dental infections, which are more common in adults 2, 3, 4
Diagnosis of Otalgia
- History and physical examination are essential in diagnosing the underlying cause of otalgia 2, 3, 4, 5
- If the diagnosis is not immediately clear, a trial of symptomatic treatment, imaging studies, and consultation may be reasonable options 2
- Computed tomography, magnetic resonance imaging, or otolaryngology consultation may be warranted when risk factors for malignancy are present 2
Treatment of Otalgia
- Ofloxacin otic solution 0.3% is effective in the treatment of otitis externa and otitis media in patients with tympanic membrane perforations or tympanostomy tubes 6
- Treatment should be directed towards the underlying pathology, and a thorough history and systematic examination are essential in arriving at a diagnosis 5
- Persistent unilateral ear pain and other alarm symptoms warrant further evaluation for possible neoplasm 3