Abstract
Ear pain is one of the most common symptoms presenting at the ENT clinic. Both children and adults can suffer from ear pain.
For each age group there is a characteristic ear pain etiology. Most of the patients come in acute stadium during first three days, the minority of the patients seek for the mediacal help later, mostly in case of mild intensity of pain.
The ear pain can present itself as sharp, dull, throbbing, burning, shoo-ting or stabbing. Generally we use the "otalgia" term for all possible types of ear pain.
Primary otalgia originates from pathologies of ear, which we can find during ear examination, whereas secondary otalgia (referred otlagia) arises from distant sources and the ear examination is normal. The most common etiology of primary otalgia is external otitis and otitis media.
Other common disease processes resulting in ear pain include trauma and tumour of external ear and middle ear. Inner ear does not have its own senzitive innervation, therefore it doesn't hurt.
The most frequent causes of referred ear pain are dental leasion, temporomandibular joint disorders and cervical joint dysfunctions. In terms of seriousness of the underlying disease, the oropharyngeal inflammations (peritonsillar abscess, parapharyngeal abscess) or tumours (tonsillar carcinoma, carcinoma of the base of te tongue) are the most important.
In terms of diagnostical difficulties the hardest primary causes to be found are remote organ leasions such as thyroid gland, oesophagus, stomach and heart. Reffered otalgia is explicated by the phenomenon of convergence of the sensory inputs from head and neck in the spinal tract nucleus of the trigeminal nerve.
Another facilitating factor for the ear pain referring is mixing of sensitive net regions due to evolution of some head and neck organs from pharyngeal branches. These organs keep their pharyngeal branch innervation even in the final localization, which might be remote to original place (glossopharyngeal nerve innervates the middle ear as well as the base of the tongue).
According to our experiences 30-50% of patients presenting with otalgia are diagnosed with referred otalgia, in the sources the number vary between 12% and 50%. The main concern in patient with referred otalgia is overlooking a life-threatening diseases which can present as ear pain.