Otolaryngology: Earache -otalgia

Earache may be due to ear disease (aural causes), or to disease elsewhere

(referred earache).

Aural causes

The most common causes are:

acute otitis media,
acute otitis externa, furunculosis and, rarely,
acute mastoiditis.

Malignant disease of the ear may cause intractable earache.

Referred earache

In referred pain pathology in a structure supplied by a sensory nerve can cause pain to be felt in another structure supplied by that same nerve. The ear has a rich nerve supply and is especially susceptible. Figure 12.1 shows the sensory nerve supply of some of the structures of the head and neck and helps to explain why referred earache is so common. Examples of structures that cause earache due to referred pain are:

teeth, temporomandibular joint or the tongue (trigeminal nerve, auriculo temporal branch);
the tonsil and the tongue base (glossopharyngeal nerve); earache can be very severe after tonsillectomy;
the larynx or pharynx;
the neck (great auricular and lesser occipital nerves).

Figure 12.1 Sensory nerve supply of the head and neck. V1, V2 and V3: first, second and third divisions of the trigeminal nerve; CN: cranial nerve; C: cervical nerve.

References

1. Flint PW, Francis HW, Haughey BH, Lesperance MM, Lund VJ, Robbins KT, Thomas JR, editors. Cummings otolaryngology: head and neck surgery. 7th ed. Philadelphia: Elsevier; 2021.

2. Watkinson JC, Clarke RW, editors. Scott-Brown's otorhinolaryngology and head and neck surgery. 8th ed. Boca Raton: CRC Press; 2018.

3. Chan Y, Goddard JC, editors. KJ Lee's essential otolaryngology: head and neck surgery. 12th ed. New York: McGraw Hill; 2019.

4. Loscalzo J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Harrison's principles of internal medicine. 21st ed. New York: McGraw Hill LLC; 2022.

5. UpToDate. Waltham, MA: UpToDate Inc. uptodate.com (Accessed: July 2026).

6. Medscape Drugs & Diseases. New York: WebMD LLC. medscape.com (Accessed: July 2026).

7. American Academy of Otolaryngology–Head and Neck Surgery. Clinical practice guidelines. Alexandria, VA: AAO-HNS. entnet.org (Accessed: July 2026).

Medical Disclaimer

Important Notice: This article is provided for educational and informational purposes only and does not constitute medical advice, diagnosis, or treatment. The content is based on current medical literature and guidelines but should not replace professional medical consultation.

Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read in this article. If you think you may have a medical emergency, call your doctor or emergency services immediately.

Individual responses to treatments may vary. What works for one person may not work for another. Treatment decisions should be made in consultation with qualified healthcare professionals who can evaluate your specific situation.

Earache -otalgia