DEFINITION:
Pain in the ear that originates outside the ear.
WHY IT HAPPENS:
Different parts of the head and neck send pain signals to the same nerves that supply the ear. The brain can’t tell where the signal started and often projects the pain into the ear.
NERVES INVOLVED:
The ear is supplied by four cranial nerves and a cervical nerve.
Trigeminal Nerve (CN 5), Facial Nerve (CN 7), Glossopharyngeal Nerve (CN 11 ), Vagus Nerve (CN 10), Cervical Plexus (C2 and C3).
These nerves also supply other areas:
Trigeminal Nerve (CN 5): Teeth, Temporo Mandibular Joint, Oral cavities
Facial Nerve (CN 7): Rare
Glossopharyngeal Nerve (CN 11): Tonsils, Base of tongue, Upper throat (pharynx)
Vagus Nerve (CN 10): Larynx, Lower throat (hypopharynx)
Cervical Nerves (C2 & C3): Cervical spine and muscles of the neck
CAUSES:
Any pathology affecting these areas, such as:
- Dental pain Temporo mandibular Joint strain, mouth ulcers, can radiate to the ear.
- Tonsillitis, post-tonsillectomy, base of tongue and upper throat malignancies can do the same.
- Lower down, any laryngeal disease and lower throat cancer, together with reflux, can refer to the ear.
- Cervical spine arthritis and even muscle strain can cause otalgia.
EVALUATION:
The patient will present with pain usually in one ear, and the duration and the radiation need to be checked. The hearing should be normal, and there should be no ear discharge.
SYMPTOMS:
Anywhere else in the head and neck, pain on chewing, swallowing problems, toothache, hoarseness, or lumps in the neck would be all relevant. Obviously, the age of the patient, whether there was weight loss, and any smoking or alcohol history.
CLINICALLY:
The ear appears normal. The Doctor needs to do a full Head and Neck examination, including flexible nasopharyngolaryngoscopy.
INVESTIGATIONS:
A CT scan or an MRI can be done if malignancy is suspected. If malignancy is seen, a Biopsy is taken.
MANAGEMENT:
Management is according to the cause and would involve a dentist, surgical excision or antibiotics.
TAKE HOME MESSAGES:
The commonest cause of referred otalgia is the teeth.
Don’t miss malignancy
A normal ear examination with persistent pain is called referred otalgia.