Ear Pain

CLINICAL DIAGNOSIS MANUAL

Ear pain, or otalgia, is a common symptom that may be related to local ear problems or pathologies affecting adjacent or even distant structures due to shared innervation. It is classified as primary otalgia when the origin is within the ear, and secondary otalgia when it arises from other anatomical areas such as the pharynx, teeth, or joints. A detailed evaluation is important to determine the cause and guide appropriate treatment.

Pathology	Symptoms and Clinical Signs	Diagnosis of Suspicion	Diagnosis of Confirmation
Acute Otitis Media	Acute pain, fever, hearing loss, otorrhoea.	Otoscopy showing a bulging and erythematous tympanic membrane.	Otoscopy, tympanometry, and presence of fluid in the middle ear, abnormal pneumatic otoscopy.
Otitis Media with Effusion	Feeling of pressure, fluctuating hearing loss, no fever.	Feeling of fullness, otoscopy with tympanic membrane retraction.	Tympanometry with reduced tympanic membrane mobility, audiometry showing conductive hearing loss.
Otitis Externa	Severe pain when moving the auricle, discharge, redness of the ear canal.	Otoscopy with inflamed ear canal and tenderness on tragal palpation.	Otoscopy and culture of the discharge if necessary to identify the causative pathogen.
Mastoiditis	Retroauricular pain, fever, oedema, and erythema over the mastoid.	History of recent otitis media, localised pain in the mastoid region.	CT scan of the temporal bone showing mastoid inflammation, signs of infection in laboratory studies.
Barotrauma	Sudden ear pain associated with pressure changes, feeling of blockage, possible tympanic haemorrhage.	History of pressure changes (e.g., air travel or diving), otoscopy with signs of haemotympanum or tympanic membrane perforation.	Otoscopy visualising damaged tympanic membrane, audiometry to assess hearing loss.
Eustachian Tube Dysfunction	Feeling of fullness, mild hearing loss, tinnitus.	Otoscopy normal or with slight tympanic retraction, symptoms associated with pressure changes.	Tympanometry showing negative middle ear pressure, audiometry to confirm conductive hearing loss.
Dental Abscess	Referred ear pain, localised dental pain, jaw or gum swelling.	History of dental caries or previous infection, facial and ear pain.	Dental X-ray or CT scan to visualise the abscess, detailed oral examination.
Upper Respiratory Tract Infections	Referred ear pain, nasal congestion, sore throat, fever, rhinorrhoea.	History of cold or pharyngitis, ear pain with no local signs on otoscopy.	Clinical diagnosis based on history and physical examination, throat culture if necessary.
Pharyngitis or Tonsillitis	Sore throat, fever, referred ear pain, difficulty swallowing.	Throat examination showing inflammation and erythema, tonsillar exudate.	Rapid strep test, throat culture, PCR if bacterial infection is suspected.
Oropharyngeal Cancer	Persistent unilateral ear pain, dysphagia, weight loss, ulcers in the mouth or pharynx.	History of smoking, persistent unilateral pain, visible oropharyngeal ulcers.	Biopsy of the lesion, CT or MRI to assess extent, laryngoscopy for direct visualisation of the oropharynx.
Glossopharyngeal Neuralgia	Paroxysmal unilateral pain in the ear, throat, or base of the tongue, worsened by swallowing or speaking.	History of electric shock-like pain triggered by mouth movements.	Clinical diagnosis based on history, trial response to anticonvulsant medications (e.g., carbamazepine).
Osteoarthritis or Arthritis of the Temporomandibular Joint	Pain in the temporomandibular joint, joint clicking, referred ear pain, difficulty opening the mouth.	Localised pain in the TMJ, crepitus, or limitation of mandibular movement.	X-ray or CT scan of the temporomandibular joint to visualise joint changes, evaluation by a TMJ specialist.