1. Department of Otorhinolaryngology

2. Ossama Mahmoud Professor of otorhinolaryngology Ain Shams University
EAR PAIN (OTALGIA)
Ossama Mahmoud
Professor of otorhinolaryngology
Ain Shams University

3. Nerve Supply of the Ear Richly innervated
Multiple cranial & spinal nerves
Shared nerve supply with other head & neck sites
Inner ear has no sensory supply

4. Nerve Supply of the Ear Great auricular nerve (cervical plexus C 2,3)
Most 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

5. Nerve Supply
Lesser occipital nerve
Greater auricular nerve

6. Nerve supply of pinna

7. Nerve supply of external auditory canal
Great auricular nerve
Auriculo temporal nerve
Arnold nerve

8. Otalgia 2 types Primary otalgia
Pain that arises from a pathology within the ear (external , middle)
Referred otalgia
Pain that originates from outside the ear

9. Otalgia: Differential Diagnosis
Primary
Otitis media
Otitis externa
Mastoiditis
TM perforation
Foreign body
Referred
Dental
TMJ
Dental abscess
Poorly-fitting denture
Oral cavity
Tongue
Sinuses
Throat
Tonsillitis/pharyngitis
Eustachian dysfunction
Neck
Musculoskeletal
Other
Neuralgias
Tumors
Angina
Temporal arteritis
Zoster

10. Otalgia (clinical exam.)
Ear normal? No
Yes
Thorough head and neck exam
Done

11. Primary otalgia Common causes: Infections of pinna
external auditory canal (boil)
middle ear / mastoid (otitis media, mastoiditis)
Neoplasms of external & middle ear

12. 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

13. Why referred otalgia occurs ?
Irritation of the large array of nerves their distant branches ↓ Cause perception of pain within the ear

14. When to label as referred otalgia ?
CLINICALLY (& radiologically) NORMAL Pinna External auditory meatus Tympanic membrane Mastoid process

15. Causes of Referred Otalgia
Nerves
C 2,3 V
VII IX X

16. Common Causes of Referred Otalgia
Dental sources
Impacted tooth (last molar, upper)
Dental caries
Periodontal infection
Ill fitting dentures
TMJ disorders

17. Pharyngeal causes Acute tonsillitis Peritonsillar abscess
Malignant tumours – Most important
Pharynx (pyriform fossa )
Larynx
Oral cavity

18. Clinical examination (ENT & neurological) must be normal
Neuralgias
Clinical examination (ENT & neurological) must be normal
Trigeminal neuralgia –
unilateral facial pain
Glossopharyngeal neuralgia
unilateral pharyngeal pain