👂 Otalgia (ear pain) can be due to primary causes (within the ear itself) or secondary/referred causes (from jaw, throat, teeth, or sinuses). Most cases are benign, but recognising red flags such as fever, severe swelling, cranial nerve palsy, or systemic illness is crucial for safe practice. 👉 Always differentiate local ear disease from referred otalgia, and remember that adults with persistent unilateral ear pain and a normal otoscopy need exclusion of head & neck malignancy.

📊 Common Causes of Ear Pain

Condition	Symptoms	Diagnosis	Management
🌊 Otitis Externa (“Swimmer’s ear”)	Ear pain worse on pinna traction, itching, discharge, fullness	Otoscopy: inflamed, narrowed canal ± debris	Topical Abx/steroid drops, aural toilet, keep dry
🔥 Acute Otitis Media	Severe pain (esp. children), fever, irritability, ↓ hearing	Bulging, red TM; tympanometry if recurrent	Oral antibiotics (amoxicillin), analgesia, watchful waiting in mild cases
♻️ Chronic Otitis Media	Persistent discharge, hearing loss, foul smell (cholesteatoma)	Otoscopy: perforation/granulation; CT if cholesteatoma	Topical Abx, surgery (tympanoplasty/mastoidectomy)
🎈 Eustachian Tube Dysfunction	Ear pressure, muffled hearing, difficulty equalising (flights/diving)	Retracted TM, tympanometry	Nasal steroids, decongestants, Valsalva; grommets if chronic
💥 Mastoiditis (Emergency)	Severe pain, fever, swelling behind ear, auricle pushed forward	Clinical + CT mastoid	IV antibiotics, mastoidectomy if abscess or unresponsive
🦷 TMJ Dysfunction	Ear pain worse on chewing, jaw clicking, tenderness	Clinical exam; MRI if persistent	NSAIDs, jaw physiotherapy, bite splints, dental referral
🧸 Foreign Body (common in children)	Sudden pain, hearing loss, bleeding/discharge	Seen on otoscopy	Careful removal; avoid irrigation if organic; topical Abx if inflamed
✈️ Barotrauma	Pain during altitude changes, ear fullness, perforation possible	Otoscopy ± tympanometry	Decongestants, nasal steroids, Valsalva; observe for perforation healing
🦠 Herpes Zoster Oticus (Ramsay Hunt)	Severe otalgia, vesicles around ear, VII palsy, hearing loss, vertigo	Clinical diagnosis; MRI if atypical	Acyclovir + steroids, analgesia, physiotherapy for facial palsy

💡 Commentary & Teaching Pearls

🔑 Primary vs secondary otalgia: Always examine throat, teeth, TMJ if ear looks normal.
🚩 Red flags: fever + mastoid swelling, facial palsy, severe systemic upset → urgent ENT referral.
👶 Children: recurrent AOM can cause speech delay → refer for grommets/hearing assessment.
🧑‍⚕️ Adults: unilateral persistent ear pain with normal ear exam = suspect malignancy (refer 2WW).
✈️ Barotrauma and 🎈 Eustachian tube dysfunction are common in travellers/divers → prevention advice is key.

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Ear Pain (Otalgia)

📊 Common Causes of Ear Pain

💡 Commentary & Teaching Pearls

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