Ear Pain

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What is Ear Pain?

Ear Pain, also known as earache or otalgia, is pain that is felt in the ear and may either originate from within the ear, or it may originate from a location outside the ear. Primary otalgia which is pain that originates in the ear is more common in children and in males, whereas referred to otlagia which is pain felt in the ear but not originating from it, is more common in adults and in females.

Is the Ear Pain condition a Medical emergency?

It is not a medical emergency, but seeking early medical attention is always advisable.

Types

It may be of the following types:

  • Primary otalgia: The origin of the pain is from within the ear
  • Referred otalgia: The origin of the pain is located outside the ear but the pain is felt within the ear

Causes

A number of conditions can cause Ear Pain. Some of them are as follows:

  • Primary otalgia:
    • External ear causes:
      • Trauma
      • Auricular cellulitis
      • Infection of the perichondrium surrounding the ear cartilage
      • Otitis externa (swimmer’s ear): Infection of the external ear canal, mostly due to staphylococcus aureus
      • Mechanical obstruction due to earwax impaction, or foreign bodies
      • Herpes zoster affecting the external ear
      • Tumors (squamous cell carcinoma) of the external ear canal
    • Middle ear:
      • Acute otitis media: Infection of the middle ear
      • Barotrauma
      • Eardrum rupture
    • Referred otalgia:
      • Dental pain
      • Sinusitis
      • Eustachian tube dysfunction
      • Inflammation of the joints of the jaws
      • Myofascial pain syndrome
      • Bells palsy
      • Trigeminal neuralgia
      • Cancers of the oral cavity
      • Inflammation of the salivary glands (parotid glands)
      • Pharyngitis
      • Laryngitis and laryngeal tumors
      • Esophagitis
      • Gastroesophageal reflux disease (GERD)
      • Myocardial infarction, angina pectoris
      • Temporal arteritis
      • Spine trauma

Symptoms & signs

Ear Pain may be felt in one or both ears. It may be continuous or intermittent. In addition to pain, some other symptoms that may be seen include:

  • Tinnitus (ringing in the ears)
  • The fullness of the ears
  • Dizziness
  • Fever
  • Hearing loss

Investigations

Some investigations that are advised for the evaluation of Ear Pain may include:

  • Laboratory tests:
    • CBP & ESR
    • Thyroid profile
  • Imaging tests:
    • Chest X-Ray
    • Dental radiography
    • CT scan of the head and sinuses
    • Panorex imaging: To assess temporomandibular joint dysfunction
    • PET scanning: If tumors are suspected
  • Audiography
  • Vestibulocochlear testing
  • Nasal endoscopy
  • Laryngoscopy
  • Upper GI endoscopy

Diagnosis

A diagnosis of the type of Ear Pain and the underlying cause is established based on medical history, clinical evaluation, and results of the investigations done.

Treatment options

The treatment of Ear Pain is dependent on first identifying the underlying cause and treating it. It may include medical and surgical management or conservative therapy as required.

Medical management

Medical management of Ear Pain may include:

  • Broad-spectrum antibiotics: For the management of bacterial infections
  • Antivirals: For the management of viral infections such as herpes simplex, etc
  • Antifungals: For the management of fungal infections
  • Antacids: For the management of GERD
  • Analgesics: For relief from pain

Interventional including surgery and indications for surgery

Interventional procedures may be required for the management of a few underlying causes and may include:

  • Incision and drainage: If infected cysts or abscesses are present
  • Foreign body removal
  • Surgical debridement for the management of inflammation of the tissue surrounding the ear cartilage
  • Removal of impacted cerumen, or keratin deposits

Complications

Untreated infections of the middle and external ear that are causing otalgia may lead to complications such as brain abscess, meningitis, epidural abscess, permanent hearing loss.

Prognosis

The prognosis for otalgia is generally very good, although it also depends on the underlying cause. Most causes of earache are mild and not life-threatening.

When to contact the doctor or hospital? / How to identify the emergency or complications?

It is advisable to seek medical attention if there is a persistence of otalgia, especially if other symptoms such as fever, dizziness, etc. are present.

Indications for hospitalization if required

Hospitalization is not required for the management of earache unless surgical interventions are advised.

Suggested clinical specialist/ Departments to consult for this condition

  • ENT
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