BMJ  2008;336:276-277 (2 February), doi:10.1136/bmj.39364.643275.47

Practice

10 Minute Consultation

Otalgia

M A Siddiq, senior fellow in otology, neuro-otology and skull base surgery1, M J Samra, general practitioner2

1 Department of Otorhinolaryngology, Head and Neck Surgery, New Cross Hospital, Wolverhampton, 2 Penn Manor Medical Centre, Penn, Wolverhampton

Correspondence to: M A Siddiq, Department of Otorhinolaryngology, Head and Neck Surgery, Manchester Royal Infirmary, Manchester M13 9WL azhersiddiq@hotmail.com

The first 150 words of the full text of this article appear below.


  • Findings on otoscopy are usually diagnostic for earache
  • Patients with persistent pain, cranial nerve involvement, headache, and vertigo may need referral
  • Referred otalgia may originate from the temperomandibular joint, teeth, pharynx, and larynx


A 35 year old patient presenting with a three day history of unilateral otalgia and fever is diagnosed as having acute otitis media and prescribed amoxicillin. He returns three days later with persistent fever and headache.

Pain varies widely from severe pain of acute otitis media to the deep boring otalgia of malignant otitis externa (pseudomonal osteomyelitis of the temporal bone). Sharp lancinating pain indicates neuralgia.

Otorrhoea—purulent otorrhoea can follow acute otitis media, but if it is persistent cholesteatoma may be present. Watery otorrhoea is seen in otitis externa, but after head injury it indicates a leak of cerebrospinal fluid.

Hearing loss may be seen in all the above conditions.

Itching is a cardinal symptom of . . . [Full text of this article]


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