Otalgia - Causes and Symptoms

Definition

Otalgia (or pain in the ear) is usually caused by inflammatory processes in the outer and middle ear, resulting in infections, obstructions or traumas.

The intensity of the pain can vary from a slight discomfort to very intense pain. The onset of otalgia can be sudden or gradual. In addition, pain may occur in isolation or in association with otorrhea, tinnitus or, more rarely, hearing loss.

The most frequent causes of acute otalgia are infections of the middle and external ear, while chronic pain (> 2-3 weeks) is often due to chronic otitis externa and dysfunctions of the eustachian tube and the temporal joint - mandibular (ATM).

Otological causes

Otitis media (acute or chronic) causes painful inflammation of the middle ear; the otalgia is strong, persistent and pulsating. On otoscopic examination, the tympanic membrane is red (usually pearl gray) and protruding. Symptoms such as fever and swelling of the regional lymph nodes of the neck are also associated.

Purulent otitis has an intense purulent exudation which occupies the tympanic charge and diffuses towards the ear of the ear (otorrhea). This process is associated with continuous otalgia.

Barotraumatic otitis, on the other hand, is the consequence of a lack of balance between the pressure of the external atmosphere and the middle ear. This event may occur, for example, during a scuba dive, during an air flight or during a climb in the high mountains, especially if there is an obstruction of the Eustachian tube.

Otalgia can also depend on mastoiditis, local trauma, obstructions and foreign bodies.

In pediatric age, the increase in mucus in the middle ear (tubal catarrh) leads to a sense of auricular fullness and decreased hearing. This phenomenon is often a consequence of adenoid hypertrophy.

It causes a sense of occlusion with decreased hearing, pain or ear buzzing even a wax plug.

Furthermore, during the evaluation of chronic otalgia, an ear tumor must be considered, especially if the patients are elderly, diabetic or immunosuppressed.

Non-otological causes

In some cases, ear pain does not derive directly from an otological pathology, but from contiguous processes (in particular, in the nose, paranasal sinuses, nasopharynx, teeth, gums, mandible, parotid glands, tongue, palatine tonsils, pharynx) and larynx). In such circumstances, the origin of otalgia is to be attributed to the interest of areas innervated by cranial nerves responsible for the sensitivity of the external and middle ear (V, IX, X).

The non-otological causes of ear pain include neoplasms (in particular, for nasopharynx, tongue and larynx), infections (Herpes zoster, tonsillitis, sinusitis, mumps and dental abscess), temporomandibular joint disorders (ATM), inflammation of the trigeminal nerve and other neuralgia.