Otalgia

1. What is otalgia?

Otalgia is ear pain, commonly referred to as an “ear ache”. Primary otalgia exists when the pain originates within the ear. Referred otalgia is pain that originates outside of the ear. When primary otalgia is present, an ear examination typically shows some abnormality of the outer or middle ear. When referred otalgia is present, the ear examination is typically normal. Otalgia may or may not be associated with balance disorders and a reduction in hearing.

2. What causes otalgia?

Common sources of primary otalgia include: otitis media (ear infection), mastoiditis, tumors, trauma, and infections of the outer ear or ear canal, and Eustachian tube dysfunction, which is the inability for the middle ear to pressurize properly. Tumors of the temporal bone, such as meningiomas, glomus jugulare and some types of lesions such as cholesteatoma, have been associated with otalgia, possibly because of nerve root compression or invasion.

Due to the complex nature of the nervous system, determining the origin of referred otalgia can be extremely difficult because it can come from many other areas of the body.

Referred otalgia can originate from:

• dental problems
• cervical spine arthritis
• tempromandibular joint dysfunction (TMJ).
• Sinusitis
• Neck and throat problems, including trauma, tonsillitis and pharyngitis (sore throat)
• Areas remote to the ear where nerves which also serve the ear may be involved

3. What is the treatment for otalgia?

A specialized interdisciplinary team of professionals is necessary to treat all of the issues associated with otalgia. This group of individuals should include an Otologist or Otolaryngologist, an Audiologist and other medical professionals as deemed necessary by the Otologist. All of these health care professionals should have extensive experience in pediatric medicine. Frequently, a scan looking at structure potentially responsible will be necessary either in-house (CEI has CT scanning facilities in our Palo Alto office) or out of house with tests like MRI’s.

The California Ear Institute is a leading global center for otological, otolaryngological and audiological treatment. Dr. Joseph Roberson and Dr. Katrina Stidham, both board certified neurotologists, have treated numerous patients for primary and referred otalgia. In the case where referred otalgia is suspected to involve the sinuses, Dr. Winston Vaughan or Dr. Karen Fong, physicians from CEI’s sister organization the California Sinus Institute will work closely with your CEI physician to address both your otalgia and the root sinus problem causing the otalgia.

4. What are the consequences of avoiding treatment?

Patients must seek medical treatment for any change in hearing or balance regardless of whether or not otalgia is also present. Evaluation for beneficial drug treatment or surgery cannot be established without a comprehensive medical examination and associated testing. Avoiding medical evaluation for otalgia or any other hearing or balance impairment related condition is not recommended, and can lead to permanent hearing loss. While relatively common for short periods, prolonged otalgia may be a sign of a serious medical condition.

Additional notes

Patients searching the internet for information about otalgia or any other medical issue should know when reading about individual case histories, that generally it is the patients with the most severe symptoms who either post their own experiences or are included in medical review journals. As a result, it is easy to become overly alarmed and assume the worst. Patients should keep this in mind as they explore the available resources, and look for sources that are certified by HON or other reputable health reviewing organizations. As with all medical conditions, prompt treatment by experienced medical personnel give the best chance for a positive outcome.

Conclusion

If you suspect that you have otalgia or you have noticed a change in your hearing or balance, consult a CEI otologist. The outlook for treatment is excellent, once the diagnosis has been made and appropriate treatment is initiated.

Click here to make an appointment with the California Ear Institute to consult with one of our board certified otologists regarding your ear-related condition.

Additional Reading

• Siddig MA, Samara MJ. Otalgia. BMJ. 2008 Feb 2; 336(7638):276-7. Review.
• Ely JW, Hansen MR, Clark EC. Diagnosis of ear pain. Am Fam Physician. 2008
  Mar 1; 77(5): 621-628.
• Jaber JJ, Leonetti JP, Lawrason AE, Feustel PJ. Cervical spine causes for referred
  Otalgia. Otolaryngol Head Neck Surg. 2008 Apr;138(4): 479-85.
• Abou-Atme YS, Melis M. Zawari KH, Cottogo L. Five year follow-up of
  temporomandibular disorders and other musculoskeletal symptoms in dental
  students. Minerva Stomatol. 2007 Nov-Dec; 56(11-12):603-9.
• Sakas DE. Panouias IG. Stanjalis G. Stefanatou MP, Maratheftis N, Bontozoglou
  N. Paroxysmal otalgia due to compression of the intermediate nerve: a distinct
  syndrome of neurovascular conflict confirmed by neuroimaging. Case report. J
  Neurosurg. 2007 Dec; 107(6):1228-30.

1. http://www.emedicine.com/ent/TOPIC199.HTM
   
2. http://www.fpnotebook.com/ENT/Sx/Otlg.htm
   
3. http://www.medscape.com/viewarticle/407597_5