Intended for healthcare professionals

Practice 10-Minute Consultation

Recurrent otalgia in adults

BMJ 2016; 354 doi: (Published 15 September 2016) Cite this as: BMJ 2016;354:i3917

For a related CPD/CME module please go to BMJ Learning

Chinese translation


  1. Samuel Finnikin, academic general practitioner1,
  2. Alistair Mitchell-Innes, ear, nose, and throat registrar2
  1. 1Department of Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
  2. 2University Hospital Birmingham
  1. Correspondence to: finniksj{at}
  • Accepted 1 July 2016

What you need to know

  • Otitis externa is the most common cause of recurrent ear pain in adults

  • Persistent symptoms in otitis externa can be caused by incorrect use of treatment or failure to deal with predisposing factors

  • Simple advice on avoiding predisposing factors in otitis externa and use of ear drops can prevent important morbidity from recurrent problems

A 43 year old man presents with right sided earache. He says he’s had two or three similar episodes in the past year, which were treated elsewhere with drops. He’s not sure if it’s always the same ear

Earache or pain is a common presenting problem, usually caused by otitis media or otitis externa.1 Although data on the causes of recurrent otalgia are lacking, one year prevalence of otitis externa among UK adults is more than 1%, indicating a substantial burden of disease.2 Rarely eustachian tube dysfunction, mastoiditis, referred pain, or malignancy can present with recurrent ear pain.

What you should cover

Find out whether the pain is primary (originating from the ear) or secondary (referred). Malignancy tends to cause unilateral symptoms. Cover associated otological symptoms—for example, deafness and otorrhoea—and take a thorough ear, nose, and throat history, including previous conditions or surgery to rule out secondary otalgia. Think beyond the ear; recurrent otalgia can be referred from elsewhere. Ask about problems with swallowing, chewing, and facial …

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