EARACHE
&
REFERRED OTALGIA
Col Shoaib Ahmed
MBBS (Honours) FCPS FRCS (Glasgow)
Classified ENT Specialist & Head & Neck Surgeon
CMH Rawalpindi
*
Nerve Supply of Ear
• Richly innervated
• Multiple cranial & spinal nerves
• Shared nerve supply with other head &
neck sites
• Inner ear has no sensory supply
Details of nerves
Most of the external ear
•
Great auricular nerve (cervical plexus C 2,3)
• Auriculo temporal nerve (branch of Vc)
Small contributions from
• Auricular branch of X nerve
• Somatosensory branch of VII nerve
Middle ear supply
• Tympanic branch of IX nerve
Nerve Supply
Lesser
occipital
nerve
Greater
auricular
nerve
Nerve supply of pinna
Nerve supply of external auditory canal
Great
auricular
nerve
Auriculo
temporal nerve
Arnold nerve
Otalgia is ear pain
• 2 types
• Primary otalgia
Pain that arises from a pathology within the
ear (external , middle)
• Referred otalgia
Pain that originates from outside the ear
Primary otalgia
• Common causes
• Infections of pinna
•
external auditory canal (boil)
•
middle ear / mastoid (otitis
media, mastoiditis)
• Neoplasms of external & middle ear
Referred Pain
• Pain felt at a site different from the location of the injured or
diseased part of the body
• Nerve signals from several areas of the body may "feed" the
same nerve pathway leading to the spinal cord and brain
•
•
•
•
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EXAMPLES
Pain of coronary artery insufficiency
Gall bladder pain
Appendix
Liver
Why referred otalgia occurs ?
• Irritation of the large array of nerves
their distant branches
↓
Cause perception of pain within the ear
When to label as referred otalgia ?
• CLINICALLY NORMAL
Pinna
External auditory meatus
Tympanic membrane
Mastoid process
Causes of Referred Otalgia
Nerves
C 2,3
V
VII
IX
X
Common Causes of Referred Otalgia
• Dental sources
Impacted tooth (last molar, upper)
Dental caries
Periodontal infection
Ill fitting dentures
Pharyngeal causes
• Acute tonsillitis
• Peritonsillar abscess
• Malignant tumours – Most important
Pharynx
Larynx
Oral cavity
Neuralgias
• Clinical examination (ENT & neurological)
must be normal
• Trigeminal neuralgia –
unilateral facial pain
• Glossopharyngeal neuralgia
unilateral pharyngeal pain
Commonest Causes
• Teeth
• TM joint
• Tongue (base)
• Tonsils
• Pharynx
• Larynx
DEPARTMENT OF ENT HEAD & NECK
SURGERY
COMBINED MILITARY HOSPITAL
RAWALPINDI
Any Questions ?