The differential diagnosis of ear pain can be categorized by the anatomic site from which the pain originates. Patients with primary otalgia have pain originating from the ear itself. Secondary otalgia is referred pain, originating in another anatomic site but causing the sensation of arising from the ear.
Cases of secondary otalgia will be distinguished from primary otalgia by the absence of findings in the ear itself and by the findings of inflammation, infection, or injury to adjacent structures. The referred pain arises from nerves that partially innervate the auricle or external auditory canal and include spinal nerves C2 and C3 and cranial nerves V, VII, IX, and X.
●Diagnostic approach
A careful history and physical examination typically provide the etiology of most cases of ear pain. Ancillary testing may be appropriate in cases where more serious diagnoses are suspected (eg, patients with serious trauma, abnormal mental status, or ill appearance).
•Stabilization
For patients with altered mental status, abnormal vital signs, or other signs of severe illness, resuscitation and emergency therapy precedes evaluation. In patients with traumatic injury and altered mental status, basilar skull fracture or intracranial hemorrhage and increased intracranial pressure should be suspected.
•Ear pain in the trauma patient
Among stable patients with ear pain, it is useful to consider separately those patients with history or signs of traumatic injury to the ear, including blunt, penetrating, and barometric trauman. Patients with ear trauma should also be evaluated for traumatic injury to adjacent structures, particularly brain injury, basilar skull fracture, and neck injury.
•Nontraumatic ear pain
The diagnostic approach to nontraumatic ear pain in stable patients consists of careful examination of the external and middle ear.
