From the Guidelines
Ear pain, also known as otalgia, can be caused by various conditions, including ear infections such as otitis media or otitis externa, earwax buildup, pressure changes, foreign objects in the ear canal, and temporomandibular joint (TMJ) disorders, as well as referred pain from throat infections, dental problems, or sinus infections 1. The causes of ear pain can be broadly categorized into infectious and non-infectious etiologies. Infectious causes include:
- Otitis media (OM), which is an inflammation of the middle ear, often caused by bacterial or viral infections 1
- Otitis externa, also known as swimmer's ear, which is an infection of the outer ear canal 1 Non-infectious causes include:
- Earwax buildup, which can cause discomfort and pain in the ear 1
- Pressure changes during air travel or diving, which can cause ear pain due to the inability of the eustachian tube to equalize pressure 1
- Foreign objects in the ear canal, which can cause pain and discomfort 1
- TMJ disorders, which can cause referred pain to the ear 1
- Referred pain from throat infections, dental problems, or sinus infections, which can cause ear pain due to the shared nerve supply 1 It is essential to address the underlying cause of ear pain to provide complete relief. Treatment options may include antibiotic therapy for infectious causes, pain management with over-the-counter medications, and removal of foreign objects or earwax buildup. In some cases, surgical intervention may be necessary to treat underlying conditions such as TMJ disorders or to insert tympanostomy tubes to relieve pressure and drain fluid from the middle ear 1. Some key points to consider when managing ear pain include:
- Accurate diagnosis of the underlying cause of ear pain is crucial to provide effective treatment 1
- Symptomatic management of ear pain and fever with analgesics is the mainstay of treatment for acute otitis media (AOM) 1
- Watchful waiting is an option for mild to moderate AOM, but antibiotics may be necessary for more severe cases or to prevent complications 1
- Tympanostomy tubes may be necessary to treat persistent otitis media with effusion (OME) and symptomatic hearing loss 1
From the Research
Causes of Otalgia
The causes of otalgia (ear pain) can be diverse and complex. Some of the possible causes include:
- Infections, such as otitis media and otitis externa, which can result from bacterial or viral infections 2, 3
- Inflammation of the external meatus or the middle ear 4
- Referred or reflex pain from other areas, such as the oropharynx or the cranial nerves 4, 5
- Neuralgia, which can be caused by irritative lesions involving the fifth, ninth, or tenth cranial nerves and spinal nerves C2 and C3 4
- Psychogenic factors, which must be identified and treated before any type of surgical therapy is recommended 4
- Environmental factors, such as swimming or minor trauma from inappropriate cleaning, which can increase the risk of developing acute otitis externa 3
- Allergies or underlying inflammatory dermatologic conditions, which can cause chronic otitis externa 3
Types of Otalgia
There are two types of otalgia:
- Primary otalgia, which originates from the ear itself 4
- Referred otalgia, which is pain felt in the ear but originates from a nonotologic source, such as the oropharynx or the cranial nerves 4, 5
Diagnosis and Treatment
A thorough understanding of the anatomy of the head and neck is required to diagnose and treat otalgia 4. The diagnosis of otalgia involves a physical examination of the ear and a review of the patient's medical history. Treatment depends on the underlying cause of the otalgia and may include topical antimicrobials or antibiotics, oral antibiotics, or other medications to manage pain and inflammation 2, 3. In some cases, surgical therapy may be necessary to treat underlying conditions that are causing the otalgia 4.