Approach to patient with otalgia

  • History - especially pertaining to onset, precipitating factors e.g. noise, duration, discharge, fever, swallowing disorder, dental history

  • Examination - auroscopy looking for causes e.g. otitis media, cerumen

  • If auroscopy unremarkable consider referred causes of pain and examine cranial nerves especially Vth, IXth and Xth

  • Also examine - the nose, sinuses, oro- and nasopharynx (occult carcinoma often presents with otalgia), TMJ , parotid glands, larynx, trachea

  • Check temperature

  • Investigations depend on the suspicion from the history and examination - the following can be performed FBC, TFT's, ESR, chest X ray and audiography

Management

  • Analgesia

  • Treat underlying cause

  • If no cause found consider re-reviewing the patient in a few days

  • If pain continues and still the cause is unclear consider referral to specialist - there is an almost 20% risk of a sinister cause of otalgia

Prognosis
Almost 50% will have spontaneous resolution of otalgia with no underlying cause detectable.

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