Otalgia overview

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S [2]

Overview

Otalgia is ear pain or an earache. Ear pain (or Otalgia) is one of the leading complaints among children either in the primary care or in emergency setting. There are two distinct types of Otalgia: Primary Otalgia - pain that originates from pathologies within the ear, Referred Otalgia - pain that originates from pathologies outside the ear and is referred to it.

Acute Otitis media, Otitis externa, Otitis media with effusion are the three most common causes responsible for Otalgia in children. Otalgia is not always associated with ear disease. It may be caused by several other conditions, such as Impacted tooth, Sinus disease, Inflamed tonsils and infections in the nose and pharynx. The most common causes of ear pain can be identified through the description of the character, onset, and location (coupled with a physical examination).

Pathophysiology

Otalgia can be primary or referred. Primary being caused by diseases of the ear per se and referred being caused by diseases elsewhere. The ear canal is heavily innervated, and the skin lining the canal lies directly against the bone without an intervening subcutaneous layer; therefore, even mild pressure, swelling, or inflammation in this area can cause immediate and severe pain.

Causes

Otalgia can be caused by diseases involving the ear (e.g Otitis media, Otitis externa) or can be caused by diseases that cause referred pain to the Ear (e.g Dental caries, Pharyngitis).

Epidemiology and Demographics

Otalgia is often due to otitis media which is predominantly an infectious disease of children. Otitis externa is less frequent and is often observed in swimmers.

Risk Factors

Immature immune system, developmental alterations of the Eustachian tube and frequent infections are the major risk factors in children. In adults smoking, alcohol and immunosuppression form the major contributors among risk factors.

Natural History, Complications and Prognosis

Natural history, prognosis and complications depend on the disease per se. Acute otitis media, Otitis externa, mastoiditis, cholesteatoma have good prognosis as long as deeper structures of the neck are not involved. If the disease processes persist for more than 6 weeks they have a high chance of getting converted to chronic forms.

Diagnosis

Symptoms

The symptoms of an ear infection in children may include ear pain, fever, fussiness, increased crying, irritability

Physical Examination

When the ear is the source of the pain (primary otalgia), the ear examination is usually abnormal. When the ear is not the source of the pain (secondary otalgia), the ear examination is typically normal.

Laboratory Studies

It is normally possible to establish the cause of ear pain based on the history. It is important to exclude cancer where appropriate, particularly with unilateral otalgia in an adult who uses tobacco or alcohol.. Common lab tests include complete blood count, differential count of WBC, culture and screening of otorrhea, thyroid function studies - for thyroiditis, erythrocyte sedimentation rate- for Temporal arteritis, throat swabs for Tonsillitis and Pharyngitis

Treatment

Treatment of Otalgia lies in identifying the pathology, whether it exists within the ear or elsewhere. Antibiotics, antifungals, pain killers form the main stay of medical therapy. Surgical therapy is definitive for Cholesteatoma.

References

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