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ICD- 10 H 60 Otitis Externa H 65& H 66 Otitis Media H 92 Otalgia
ICD- 9 380.1 Otitis Externa 381 Otitis Media 388.7 Otalgia
DiseasesDB 18027
eMedicine ent/199

Otalgia is ear pain or an earache. Primary otalgia is from pain that originates inside the ear. Referred otalgia is from pain that originates from outside the ear.

Otalgia is not always associated with ear disease. It may be caused by several other conditions, such as impacted teeth, sinus disease, inflamed tonsils and infections in the nose and pharynx.

Primary otalgia

Ear pain can be caused by disease in the external, middle, or inner ear, but the three are indistinguishable in terms of the pain experienced.

External ear pain may be:

  • Mechanical: trauma, foreign bodies such as hairs, insects or cotton buds.
  • Infective (otitis externa): Staphylococcus, Pseudomonas, Candida, herpes zoster, or viral myringitis. (See Otitis externa)

Middle ear pain may be:

  • Mechanical: barotrauma (often iatrogenic), Eustachian tube obstruction leading to acute otitis media.
  • Inflammatory / infective: acute otitis media, mastoiditis.

Secondary otalgia

Ear pain can be referred pain to the ears in five main ways:

  • Via Trigeminal nerve [cranial nerve V]. Rarely, trigeminal neuralgia can cause otalgia.
  • Via Facial nerve [cranial nerve VII]. This can come from the teeth (most commonly the upper molars, when it will be worse when drinking cold fluids), the temporomandibular joint (due to its close relation to the ear canal), or the parotid gland.
  • Via Glossopharyngeal nerve [cranial nerve IX]. This comes from the oropharynx, and can be due to pharyngitis or tonsillitis, or to carcinoma of the posterior third of the tongue.
  • Via Vagus nerve [cranial nerve X]. This comes from the laryngopharynx in carcinoma of the pyriform fossa or from the esophagus in GERD.
  • Via the second and third cervical vertebrae, C2 and C3. This ear pain is therefore postural.

Psychogenic otalgia is when no cause to the pain in ears can be found, suggesting a functional origin. The patient in such cases should be kept under observation with periodic re-evaluation.


It is normally possible to establish the cause of ear pain based on the history. It is important to exclude cancer where appropriate, particularly with unilateral otalgia in an adult who uses tobacco or alcohol.

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