Ear pain

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Classification and external resources
ICD-10 H60 Otitis Externa H65&H66 Otitis Media H92 Otalgia
ICD-9-CM 380.1 Otitis Externa
381 Otitis Media
388.7 Otalgia
DiseasesDB 18027
MedlinePlus 003046
eMedicine ent/199
Patient UK Ear pain

Otalgia or an earache or ear pain is pain in the ear. Primary otalgia is ear pain that originates inside the ear. Referred otalgia is ear pain that originates from outside the ear.

Otalgia is not always associated with ear disease. It may be caused by several other conditions, such as impacted teeth, sinus disease, inflamed tonsils, infections in the nose and pharynx, throat cancer, and occasionally as a sensory aura that precedes a migraine.

Primary otalgia[edit]

Ear pain can be caused by disease in the external, middle, or inner ear, but the three are indistinguishable in terms of the pain experienced.

External ear pain may be:

Middle ear pain may be:

Referred pain[edit]

The neuroanatomic basis of referred earaches rests within one of five general neural pathways.[1] The general ear region has a sensory innervation provided by four cranial nerves and two spinal segments. Hence, pathology in other "non-ear" parts of the body innervated by these neural pathways may refer pain to the ear. These general pathways are:

In an adult with chronic ear pain, yet a normal ear on exam, the diagnosis is carcinoma of the head and neck region until proven otherwise. Yet some patients will have a "psychogenic otalgia," and no cause as to the pain in ears can be found (suggesting a psychosomatic origin). The patient in such cases should be kept under observation with periodic re-evaluation.

Dental disease may cause pain in the region of the ear. E.g. dental caries causing pulpitis and/or periapical periodontitis (which may be associated with a periapical abscess) in a tooth can be referred via the auriculotemporal nerve (a branch of the trigeminal nerve), the tympanic nerve (a branch of the glossopharyngeal nerve) or via the auricular nerve (a branch of the vagus nerve). Temporomandibular joint dysfunction, impacted third molar teeth, and lesions of the floor of mouth or ventral surface of the tongue (underside of the tongue) are other possible causes of dental conditions which can cause ear pain.[2]


Otitis Media is a particularly common cause of otalgia in early childhood,[3] often occurring secondary to other infectious illnesses, such as colds, coughs, or conjunctivitis.[4]


It is normally possible to establish the cause of ear pain based on the history. It is important to exclude cancer where appropriate, particularly with unilateral otalgia in an adult who uses tobacco or alcohol.[5] Often migraines are caused by middle ear infections which can easily be treated with antibiotics. Often using a hot washcloth can temporarily relieve ear pain.


Management of otalgia depends on the underlying cause.

Most cases of otitis media are self-limiting, resolving spontaneously without treatment within 3–5 days. Age-appropriate analgesics or a warm washcloth placed over the affected ear can help relieve pain until the infection has passed.[6]


  1. ^ Scarbrough TJ; Day, TA; Williams, TE; Hardin, JH; Aguero, EG; Thomas Jr, CR (2003). "Referred otalgia in head and neck cancer: a unifying schema". American Journal of Clinical Oncology 26 (5): e157–62. doi:10.1097/01.coc.0000091357.08692.86. PMID 14528091. 
  2. ^ Quail, G; Mueller, D; Yoon, MS; Pageler, L; Diener, H; Katsarava, Z (August 2005). "Atypical facial pain--a diagnostic challenge." (PDF). Australian family physician 34 (8): 641–5. PMID 16113700. 
  3. ^ "Middle ear infection (otitis media) - Causes - NHS Choices". www.nhs.uk. Retrieved 2015-06-04. 
  4. ^ Institute for Good Medicine at the Pennsylvania Medical Society,http://www.myfamilywellness.org/MainMenuCategories/FamilyHealthCenter/AntibioticResistance/Earaches.aspx, 2009.
  5. ^ Amundson L (1990). "Disorders of the external ear". Prim Care 17 (2): 213–31. PMID 2196606. 
  6. ^ "Middle ear infection (otitis media) - Treatment - NHS Choices". www.nhs.uk. Retrieved 2015-06-04. 

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