Otalgia and Ear Pain

What Is Otalgia

Otalgia is the medical term for ear pain. There are two types of otalgia: primary and secondary. Primary otalgia is ear pain caused by a problem directly associated to the ear, such as an ear infection. Ear infections are probably the most common cause of otalgia in children. In adults, however, ear infections are not as common a reason for experiencing otalgia. Secondary otalgia is ear pain that has referred to the ear from another source of the body.

What Should I Do if I'm Experiencing Otalgia?

Your first stop should probably be a family physician or pediatrician. However, in more complicated cases that are not easily diagnosed, seeking an ENT specialist (otolaryngologist) might be a better option. There are many reasons for experiencing otalgia and your physician will assess your symptoms, health history, and conduct a physical exam to narrow down the possible diagnoses. In determining the diagnosis, your physician will be trying to differentiate from infection, growths, musculoskeletal problems, or other disorders.

What Causes Otalgia?

The potential causes of otalgia can be divided into these categories:

  • Musculoskeletal Otalgia
    • tension headache
    • Temporomandibular Joint (TMJ) disorder –- the most common cause of otalgia in adults with a normal ear exam
  • Other
    • migraine headaches
    • earwax accumulation
    • GERD
    • trauma to the ear, jaw or neck

You should be prepared to give a thorough history of your symptoms and undergo a focused physical examination when visiting your physician’s office for otalgia.

Being prepared with the answers prior to the visit will help speed up the visit and help the physician isolate the possible reasons for your ear pain.

Here is a list of some of the questions your physician may ask to help understand the source:

  • When did the otalgia start?
  • Are you experiencing any loss of hearing, ear drainage, or tinnitus?
  • Is the pain constant or intermittent?
  • Do you have periods of exacerbation and what would relieve those exacerbations?
  • Do you have any difficulty with balance or bouts of dizziness?
  • Does your child have frequent ear infections?
  • Did you have frequent ear infections as a child?
  • Have you experienced any hoarseness?
  • Do you have difficulty or pain associated with swallowing?
  • Have you lost unexpected weight recently?
  • Do you smoke or use tobacco products? How frequently (i.e. how many packs a day)?
  • Do you drink alcohol and how frequently?
  • Have you been told that you grind your teeth at night?
  • Do you notice yourself clenching your teeth during the day when you are feeling stress?
  • Do you find yourself constantly chewing gum?

Being prepared to answer these questions will be particularly useful when your visit is with a general practitioner, as they may not be as familiar with the many different diagnoses for otalgia. Presenting the answers to these questions if not asked may help guide the physician to evaluating for reasons other than ear infection as the source of otalgia.

Physical Exam for Otalgia

Your physician will do a focused assessment to help identify the reasons for otalgia based on your history. Inspection of the ear canal and tympanic membrane with an otoscope will likely be performed to look for otitis media. Observation of the outer ear will likely be performed as well looking for signs of infection or sites of trauma. A Weber Tuning Fork may also be used to help the physician determine if there is either bone or air conductive hearing loss.

Your physician will also assess your nasal and oral cavities. Looking at the molars (the back teeth) your physician will be able to assess for signs of worn molars indicating grinding or frequent clenching of the teeth. Assessment of the neck is also likely looking for enlarged lymph nodes, an enlarged thyroid, or other masses. As Temporomandibular Joint disorder is a common cause for otalgia in adults, this joint may be palpated by the physician.

Other exams may be needed to fully identify the cause of otalgia. Other exams may include laryngoscopy, endoscopy, CT scan, MRI, X-Rays, and audiometry.

Treatment of Otalgia

As there are many different causes of otalgia, there are similarly many different possible treatments. The treatment of choice will be linked to the cause of otalgia. The treatment may be as simple as antibiotics and some Tylenol or Advil, or it may involve surgery (i.e. myringotomy, total thyroidectomy, removal of cancer, etc.). Discussion with your physician will be important as to what treatment will be necessary to help relieve your otalgia. Fortunately, the majority of cases of otalgia are curable.


Chen, R.C., Khorsandi, A.S., Shatzkes, D.R., & Holliday, R.A. (2009). The Radiology of Referred Otalgia. The American Journal of Neuroradiology. Accessed: April 4, 2010 from http://www.ajnr.org/cgi/content/full/30/10/1817

Medline Plus. (2009). Earache. Accessed: April 1, 2010 from http://www.nlm.nih.gov/medlineplus/ency/article/003046.htm

Wax, M.K. (2011). Primary Cary Otolaryngology Chapter 16: Head and Neck Cancer. The American Academy of Otolaryngology – Head and Neck Surgery Foundation. Retrieved on July 31, 2015 from https://www.entnet.org/sites/default/files/Oto-Primary-Care-WEB.pdf

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