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Dr. Saeed Khali Ismail* and Dr. Abdullah Sulaiman Dawood


Otalgia, or pain localised to the ear, is a common symptom seen in general practice, emergency departments and otolaryngology clinics. Approximately 4% of general practitioner (GP) encounters are solely for ears.1 Most of the common causes of otalgia are benign conditions that can be effectively treated with routine management; however, there are more sinister diagnoses that need to be considered in some cases. Unfortunately, there is no straightforward algorithm for the assessment of otalgia. To understand otalgia and its causes and complications, a brief appreciation of anatomy is required. The major anatomical structures of the external ear (auricle) are the helix, ear lobe, tragal cartilage, conchal bowl, external auditory meatus, and canal and lateral tympanic membrane. The middle ear consists of the medial tympanic membrane and ossicles, and connects via the eustachian tube to the posterior nasopharynx. The nerve supply for sensation in the ear arises from several cranial nerves including the trigeminal nerve (CNV), facial nerve (CNVII), glossopharyngeal (CNIX) and vagus nerve (CNX) as well as the cervical plexus (Table 1). In the ear, pain fibres in the nerve endings are stimulated by distension of skin due to swelling or compression against bony or cartilaginous structures. These same nerves also supply multiple head and neck structures, and therefore make otalgia a complex symptom given the possibility of referred pain.

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