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EARACHE &
REFERRED OTALGIA
Col Shoaib Ahmed MBBS (Honours) FCPS FRCS (Glasgow)
Classified ENT Specialist & Head & Neck SurgeonCMH Rawalpindi
*
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Nerve Supply of Ear
• Richly innervated• Multiple cranial & spinal nerves• Shared nerve supply with other head &
neck sites• Inner ear has no sensory supply
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Details of nervesMost of the external ear
• Great auricular nerve (cervical plexus C 2,3)• Auriculo temporal nerve (branch of Vc)
Small contributions from• Auricular branch of X nerve• Somatosensory branch of VII nerve
Middle ear supply• Tympanic branch of IX nerve
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Nerve Supply
Greater auricular nerve
Lesser occipital nerve
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Nerve supply of pinna
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Nerve supply of external auditory canal
Auriculo temporal nerve
Arnold nerve
Great auricular nerve
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Otalgia is ear pain
• 2 types• Primary otalgia Pain that arises from a pathology within the
ear (external , middle)• Referred otalgia Pain that originates from outside the ear
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Primary otalgia
• Common causes• Infections of pinna• external auditory canal (boil)• middle ear / mastoid (otitis
media, mastoiditis)• Neoplasms of external & middle ear
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Referred Pain
• Pain felt at a site different from the location of the injured or diseased part of the body
• Nerve signals from several areas of the body may "feed" the same nerve pathway leading to the spinal cord and brain
• EXAMPLES• Pain of coronary artery insufficiency • Gall bladder pain• Appendix• Liver
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Why referred otalgia occurs ?
• Irritation of the large array of nerves their distant branches
↓Cause perception of pain within the ear
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When to label as referred otalgia ?
• CLINICALLY NORMALPinnaExternal auditory meatusTympanic membraneMastoid process
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Causes of Referred Otalgia
NervesC 2,3VVII IXX
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Common Causes of Referred Otalgia
• Dental sourcesImpacted tooth (last molar, upper)Dental cariesPeriodontal infectionIll fitting dentures
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Pharyngeal causes
• Acute tonsillitis• Peritonsillar abscess• Malignant tumours – Most important
PharynxLarynxOral cavity
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Neuralgias
• Clinical examination (ENT & neurological) must be normal
• Trigeminal neuralgia – unilateral facial pain
• Glossopharyngeal neuralgiaunilateral pharyngeal pain
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Commonest Causes
• Teeth• TM joint• Tongue (base)• Tonsils• Pharynx• Larynx
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DEPARTMENT OF ENT HEAD & NECK SURGERY
COMBINED MILITARY HOSPITAL
RAWALPINDI
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Any Questions ?