Intended for healthcare professionals

Practice 10 Minute Consultation


BMJ 2008; 336 doi: (Published 31 January 2008) Cite this as: BMJ 2008;336:276
  1. M A Siddiq, senior fellow in otology, neuro-otology and skull base surgery1,
  2. M J Samra, general practitioner2
  1. 1Department of Otorhinolaryngology, Head and Neck Surgery, New Cross Hospital, Wolverhampton
  2. 2Penn Manor Medical Centre, Penn, Wolverhampton
  1. Correspondence to: M A Siddiq, Department of Otorhinolaryngology, Head and Neck Surgery, Manchester Royal Infirmary, Manchester M13 9WL azhersiddiq{at}
  • Accepted 1 April 2007

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


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 …

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