Otalgia (Ear Pain) Causes and Treatment

Woman suffering from an ear ache
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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 ear pain in children. In adults, however, ear infections are not as common a reason for experiencing ear pain. Secondary otalgia is ear pain that actually comes from another source in 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 ear pain and your physician will assess your symptoms, health history, and conduct a physical exam to narrow down the possible diagnoses. In determining the cause of your ear pain, your physician will be trying to detect an infection, growths, musculoskeletal problems, or another disorder.

What Causes Ear Pain?

The potential causes of ear pain can be divided into these categories:

  • Ear pain caused by an infection
  • Ear pain caused by an abnormal growth
    • cancers involving the ear, parotid gland, or aerodigestive tract
    • benign/malignant growths on or near certain nerves
  • Musculoskeletal ear pain
    • 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 physical examination when visiting your physician’s office for ear pain. Here is a list of some of the questions your doctor may ask:

  • When did the pain start?
  • Are you experiencing any loss of hearing, ear drainage, or tinnitus (ringing in the ears)?
  • Is the pain constant or does it come and go?
  • Do you have any difficulty with balance or bouts of dizziness?
  • Do you suffer from frequent ear infections?
  • Did you have frequent ear infections as a child?
  • Have you experienced any hoarseness or other cold like symptoms?
  • 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 if so 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?
  • Have you had any recent accidents or injured your ear, face, jaw, or head?

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 ear pain.

Physical Exam for Otalgia

Inspection of the ear canal and tympanic membrane (ear drum) with an otoscope will likely be performed to look for otitis media. Your doctor will also look at your outer ear to check for signs of infection (swimmer's ear) or injuries. 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. Your doctor may also look at your back molars to check for signs of grinding or frequent clenching of the teeth. Assessment of the neck is done to look for enlarged lymph nodes, an enlarged thyroid, or other masses. As Temporomandibular Joint disorder (TMJ) 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 specifically depend on the root cause of your ear pain. The treatment may be as simple as antibiotics and some over-the-counter pain reliever. More complex cases may require more invasive treatments such as surgery (i.e. myringotomy, total thyroidectomy, removal of cancer, etc.).  Fortunately, the majority of cases of otalgia are curable.

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