Ear Pain

Clinical Presentations » Otalgia

Definition ≡ Pain in or around the ear


Common. primary vs secondary otalgia.


  • detailed history helps differentiate between primary vs secondary causes and narrows differential
  • onset, duration, quality of pain
  • associated symptoms in otologic (primary) otalgia: purulent otorrhea, decreasing hearing, previous ear surgery
  • associated symptoms in secondary otalgia: voice change, mastication or swallowing pain, purulent rhinorrhea

Physical Exam

  • complete physical exam with a thorough head and neck exam including otoscopy (special emphasis on ear, upper aerodigestive tract, dental structures, neck and cranial nerves, TMJ)
  • mild inflammation in external and middle ear do not rule out referred otalgia

Differential Diagnosis of Otalgia



Indications for Referral

  • Any focal mucosal lesion, asymmetrical ulceration or masses in aerdigestive tract require further investigation and biopsy.
  • Any focal neurological deficit noted during physical exam