Post-Tonsillectomy Jaw and Ear Pain
This is most likely referred pain (Option B), which is an expected and common postoperative symptom following tonsillectomy. 1, 2
Why Referred Pain is the Correct Answer
Referred otalgia (ear pain) is explicitly recognized as a common postoperative symptom after tonsillectomy, along with throat pain that can radiate to the jaw and ear regions. 1 This occurs due to shared nerve pathways between the tonsillar fossa and the ear, particularly through the glossopharyngeal nerve (cranial nerve IX). 3
Key Clinical Features Supporting Referred Pain:
Tonsillectomy is identified as one of the most painful surgical procedures, with pain and discomfort being the main causes of morbidity after the operation. 4
Pain typically lasts 11-12 days postoperatively, with more than 50% of patients requiring rescue analgesia during the first week. 5
Referred otalgia is specifically listed among common postoperative symptoms alongside throat pain, nausea, vomiting, and dehydration. 1, 2
The pain pattern is predictable: moderate pain on the day of surgery continuing for several days, with adenotonsillectomy patients experiencing an average pain duration of 9 days. 6
Why Other Options Are Less Likely:
Infection (Option A):
- Would typically present with additional signs such as fever, purulent drainage, worsening pain beyond expected timeline, or systemic symptoms. 3
- Not the most likely cause in the immediate postoperative period when referred pain is expected.
Surgical Complication (Option C):
- While complications like hemorrhage (0.2-2.2% primary, 0.1-3% secondary) or trauma to surrounding structures can occur, these are relatively uncommon. 1, 2
- Eagle syndrome (elongated styloid process causing neck and ear pain) can rarely occur after tonsillectomy but is an uncommon sequela. 7
- Jaw and ear pain without other concerning features (bleeding, respiratory distress, severe uncontrolled pain) suggests normal postoperative course rather than complication. 1
Allergic Reaction (Option D):
- Would present with urticaria, angioedema, respiratory symptoms, or systemic manifestations—not isolated jaw and ear pain. 3
Clinical Management Approach:
Multimodal pain management should be implemented, including:
- Single intraoperative dose of intravenous dexamethasone. 1, 2
- Scheduled acetaminophen and NSAIDs (avoiding aspirin). 1
- Opioids as rescue medication when needed. 1
Reassure the patient and caregivers that jaw and ear pain is an expected part of recovery, emphasizing the importance of maintaining adequate hydration and oral intake despite discomfort. 4, 1
Red flags requiring immediate evaluation include fresh bleeding, respiratory distress, severe uncontrolled pain, or signs of dehydration—none of which are suggested by isolated jaw and ear pain. 1