Otalgia is the medical term for earache. It is a common problem that many specialities like otolaryngology, general medicine, pediatrics, emergency medicine are likely to tackle. This is a troubling symptom from which the patient expects immediate relief. The hurdle is that more that 40% of the times the cause of pain is not in the ear. The pathology is elsewhere and the brain misinterprets the pain to be arising from the ear due to similar nerves supplying both the structures. This is called referred otalgia. It is left to the clinician to search for the root cause of ear pain and treat it.
Earache is seen in all age groups from infants to elderly. Common ear conditions causing earache are those invoving the external ear and the middle ear such as Ear wax impaction, foreign body in the ear canal, boil in the external ear, swimmer’s ear (otitis externa) , myringitis (infammation of the eardrum) involve the external ear. Middle ear infection or otitis media which is usually associated with upper respiratory infections , eustachian catarrh due to block in eustachian tube, barotrauma are common middle ear conditions causing earache.
Rare causes in the ear include impending complications of middle ear infections, unsafe type of otitis media, prior to Bell’s palsy, herpez zoster oticus, skull base osteomyelitis (seen in long standing diabetesmellitus) and tumors of the ear.
Referred otalgia can be cased by problems in the oral cavity and pharynx like dental disorders, infections like tonsillitis, ulcers in the oral cavity, malignancies in the region. Pathology in the jaw joints and salivary glands also cause otalgia. Lesions in the sound box and food pipe ranging from infection to gastro esophageal reflux disease(GERD) and tumors can cause the symptom. Cervical spine disc problems, neck muscle tendinitis, pathology of lymph nodes in neck also cause earache.
Rarely, cardiac pain can also present as ear and neck ache. Neuralgias can involve the ears. At times, pain in elderly individuals can be due to secondary involvement of skull base by primary tumors elsewhere.
Tumors in the brain can also cause discomfort and pain in the ears. The key to management of otalgia is finding the cause of the pain and treating it appropriately.
Usually the local causes are easily diagnosed. It is when the cause is not detected even after thorough clinical examination and pain persists after first line analgesics and antiinflammatory medications for a week , that one has to investigate .This warrants tests like airway endoscopy, imaging studies, blood investigations which help early detection of the pathology. Involvement of appropriate specialists like neurologist, rheumatoogist and gastroenterologist are required .
Things that can be done before meeting the doctor: A dose of paracetamol If accompanied by severe cold especially in a child, decongestent nasal drops.
The don’ts are:
Use of wax dissoving ear drops
Use of warm oils in ears
Higher analgesics (that mask pain and delay proper diagnosis). Otagia is something most of us have experienced. It is not to be a cause of panic since most often the cause is obvious like a middle ear infection or an impacted wisdom tooth and can be managed. It is only when the cause is unclear and pain persists inspite of treatment that further investigations are required to rule out troublesome and rare causes of the condition.
Dr Bathi Reddy, ENT Head, Manipal Hospital, Bangalore