[Differential diagnosis of otalgia]

Otalgia is the sensation of pain in the ear, while referred otalgia is pain felt in the ear but originating from a nonotologic source. Ear pain is a diagnostic problem when examination of the ear shows no pathology. This article reviews the anatomic basis for referred otalgia and shows the common etiologies responsible for this symptom.

Pain in the ear can be caused by inflammation of the external meatus or the middle ear. Nonotogenic otalgia may be due to referred or reflex pain, neuralgia, or to a psychogenic problem. Otalgia may be referred also from primary carcinoma of the head and neck. A thorough understanding of the anatomy of the head and neck is required. A basic knowledge of neuroanatomy, with emphasis on the cranial nerves, their course, distribution, and function, is also necessary. Referred pain is due to irritative lesions involving the fifth, ninth, or tenth cranial nerve and spinal nerves C2 and C3. If pathologic problems in the area supplied by these nerves have been ruled out, the neuralgia should be considered in the differential diagnosis. Psychogenic factors must be identified and treated before any type of surgical therapy is recommended. The complexity of this field may sometimes require the treating physician to call for consultations from colleagues in the fields of oral surgery, orthopaedics, neurology, or neurosurgery.