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

Practice

10 Minute Consultation

Otalgia

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

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

Key points 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

Case history

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.

What you should cover

History
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]

Causes of referred otalgia
Examination

What you should do

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