Otalgia is ear pain or an earache. Primary otalgia is from pain that originates inside the ear. Referred otalgia is from pain that originates from outside the ear. Otalgia is not always associated with ear disease.
TYPES OF OTALGIA
Primary otalgia: 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:
Mechanical: Trauma, foreign bodies such as hairs, insects or cotton buds
Ineffective (otitis externa): Staphylococcus, Pseudomonas, Candida, herpes zoster, or viral myringitis
Middle ear pain may be:
Mechanical: Barotrauma, Eustachian tube obstruction leading to acute otitis media
Inflammatory/Infective: acute otitis media, mastoiditis
Secondary Otalgia: Ear pain can be referred pain to the ears in five main ways:
Via Trigeminal nerve (Cranial Nerve V). Rarely, trigeminal neuralgia can cause otalgia
Via Facial nerve (Cranial Nerve VII). This can come from the teeth (most commonly the upper molars, when it will be worse when drinking cold fluids), the temporomandibular joint (due to its close relation to the ear canal), or the parotid gland.
Via Glossopharyngeal nerve (Cranial Nerve IX). This comes from the oropharnyx, and can be due to pharyngitis or tonsillitis, or to carcinoma of the posterior third of the tongue.
Via Vagus nerve (Cranial Nerve X). This comes from the larynopharynx in carcinoma of the pyriform fossa or from the esophagus in GERD.
Via the second and third cervical vertebrae, C2 and C3. This ear pain is therefore postural.
Psychogenic otalgia is when no cause to the pain in ears can be found, suggesting a functional origin. The patient in such cases should be kept under observation with periodic re-evaluation.
The sensory innervation of the ear is served by the auriculotemporal branch of the fifth cranial nerve (CN V), the first and second cervical nerves, the Jacobson branch of the glossopharyngeal nerv, the Arnold branch of the vagus nerve, and the Ramsey Hunt branch of the facial nerve. Neuroanatomically, the sensation of otalgia is thought to center in the spinal tract nucleus of CN V. not surprisingly, fibers from CNs V, VII, VIV and X and cervical nerves 1,2 and 3 have been found to enter this spinal tract nucleus caudally near the medulla. Hence, noxious stimulation of any branch of the aforementioned nerves may be interpreted as otalgia.
Otalgia is managed by treating the primary problem. Identification of a causative etiology is often necessary to successfully treat referred otalgia. Once determined, most causes of referred otalgia can be readily treated.
Otalgia - Types, Pathophysiology, Diagnostic Evaluation, Assessment and Medical Management