Otalgia

doi:10.1136/bmj.39364.643275.47

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Practice

10 Minute Consultation

Otalgia

BMJ

2008; 336 doi: 10.1136/bmj.39364.643275.47 (Published 31 January 2008)

Cite this as: BMJ 2008;336:276

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 otitis …