Some Causes of Earache
Cause | Suggestive Findings* | Diagnostic Approach |
|---|---|---|
Middle ear | ||
Acute eustachian tube obstruction | Usually mild discomfort Gurgling, crackling, or popping noises, with or without nasal congestion TM not red but mobility decreased Unilateral conductive hearing loss | Clinical examination alone Sometimes audiogram |
Significant pain History of rapid change in air pressure (eg, air travel, scuba diving) Often hemorrhage on or behind TM | Clinical examination alone Sometimes audiogram | |
Recent history of otitis media May have otorrhea, redness, and tenderness over mastoid process | Clinical examination alone | |
Significant pain, often URI symptoms Bulging, red TM More common among children Possible discharge if eardrum perforated | Clinical examination alone Sometimes audiogram | |
External ear | ||
Visible on otoscopy | Clinical examination alone | |
Usually history of attempts at ear cleaning Canal lesion visible on otoscopy | Clinical examination alone | |
Itching and pain (more itching and only mild discomfort in chronic otitis externa) Often history of swimming or recurrent water exposure Sometimes foul-smelling discharge Canal red, swollen; purulent debris TM normal | Clinical examination alone CT of temporal bone if malignant external otitis suspected | |
Nonotologic causes† | ||
Cancer (nasopharynx, tonsils, base of tongue, larynx) | Chronic discomfort Often long history of tobacco or alcohol use Sometimes middle ear effusion, cervical lymphadenopathy Usually in older patients | Gadolinium-enhanced MRI Biopsy of visible lesions |
Infection (tonsils, peritonsillar abscess) | Pain with swallowing Visible pharyngeal erythema Bulging if abscess | Clinical examination alone Sometimes strep culture |
Neuralgia (trigeminal, sphenopalatine, glossopharyngeal, geniculate) | Random, brief, severe, lancinating pain | Clinical examination alone |
Pain worsens with jaw movement, lack of smooth TMJ movement | Clinical examination alone | |
* Some degree of conductive hearing loss is common in many middle and external ear disorders. † Common feature is normal ear examination. TM = tympanic membrane; TMJ = temporomandibular joint; URI = upper respiratory infection. | ||