Ear pain, also known as earache or otalgia, is pain in the ear. Primary ear pain is pain that originates from the ear. Secondary ear pain is a type of referred pain, meaning that the source of the pain differs from the location where the pain is felt. Most causes of ear pain are non-life-threatening. Primary ear pain is more common than secondary ear pain, and it is often due to infection or injury. The conditions that cause secondary (referred) ear pain are broad and range from temporomandibular joint syndrome to inflammation of the throat.In general, the reason for ear pain can be discovered by taking a thorough history of all symptoms and performing a physical examination, without need for imaging tools like a CT scan. However, further testing may be needed if red flags are present like hearing loss, dizziness, ringing in the ear or unexpected weight loss.Management of ear pain depends on the cause. If there is a bacterial infection, antibiotics are sometimes recommended and over the counter pain medications can help control discomfort. Some causes of ear pain require a procedure or surgery.83 percent of children have at least one episode of a middle ear infection by three years of age. Signs and symptoms
Ear pain can present in one or both ears. It may or may not be accompanied by other symptoms such as fever, sensation of the world spinning, ear itchiness, or a sense of fullness in the ear. The pain may or may not worsen with chewing.
There may be certain parts of the muscles or tendons (connective tissue connecting the muscles to bones) that are especially painful when pressed
Trigeminal neuralgia: attacks of shooting pain down the face that may be triggered by touching the face or temperature changes
Dental pain from cavities or an abscess
Oral cavity carcinomaConditions causing irritation of the facial nerve (cranial nerve VII) or glossopharyngeal nerve (cranial nerve IX):
Tonsillitis: infection/inflammation of the tonsils
Post-tonsillectomy: pain following surgical removal of the tonsils
Pharyngitis: infection/inflammation of the throat
Sinusitis
Parotitis: inflammation of the parotid gland, the salivary gland right in front of the ear
Carcinoma of the oropharynx (base of tongue, soft palate, pharyngeal wall, tonsils)Conditions causing irritation of the vagus nerve (cranial nerve X):
GERD
Myocardial ischemia (inadequate oxygen supply to the heart muscle)Conditions causing irritation of cervical nerves C2-C3:
Cervical spine trauma, arthritis (joint inflammation), or tumor
Temporal arteritis: an autoimmune disorder leading to inflammation of the temporal artery, a large artery in the head. This condition tends to occur in adults older than 50. Pathophysiology
Primary ear pain
The ear can be anatomically divided into the external ear, the external auditory canal, the middle ear, and the inner ear. These three are indistinguishable in terms of the pain experienced. Secondary ear pain
Many different nerves provide sensation to the various parts of the ear, including cranial nerves V (trigeminal), VII (facial), IX (glossopharyngeal), and X (vagus), and the great auricular nerve (cervical nerves C2-C3). These nerves also supply other parts of the body, from the mouth to the chest and abdomen.