Editors

TimoAtula

Ear Pain in an Adult

Primary ear pain originates from the ear or adjacent structures.
Secondary pain is referred from a more distant process.
If the cause of pain cannot be localized to the ear region, consider the possibility of referred ear pain from any structure in the pharynx or neck.

The pain may be caused by acute inflammation or injury.
Cold air and wind may cause pain in the ear canal. Such pain, however, is usually rapidly relieved by warmth.
Negative pressure: infection, barotitis or barotrauma Middle Ear Barotrauma (Ear Problems Associated with an Increase in Atmospheric Pressure)
Pain in chronic otitis media Chronic Otitis Media often indicates a complication.
Tumours in the ear canal Lesions and Tumours of the Ear Canal or middle ear are very rare causes of ear pain.
Neuralgia of the facial nerve or tympanic plexus is similarly a very rare cause of pain.

Ear pain quite often has its origin in the temporomandibular joint or the dental occlusion Malocclusions of the Teeth. Temporomandibular pain is often felt in the ear rather than in the joint itself. Dental pain may radiate to the ear. Examine the teeth of a patient with unexplained ear pain and palpate the masticatory muscles and temporomandibular joints. If the cause of pain remains unclear, an evaluation by a dentist is warranted.
Pain originating from the neck is commonly referred to the ear. Tension neck Neck and Shoulder Pain often causes pain in the insertion of the sternocleidomastoid muscle. Ear pain may also have a cervical aetiology. Palpation of the muscles of the neck is important in the assessment of a patient suffering from ear pain.
Diseases of the pharynx are common causes of referred ear pain. The pain caused by tonsillitis Sore Throat and Tonsillitis or a peritonsillar abscess Peritonsillitis and Peritonsillar Abscess may be reflected to the ear by the glossopharyngeal nerve.
Pain originating from the pharynx, tongue, or palate may be caused by a barely visible abnormality, e.g. a small tumour.
Diseases in the parotid gland Swelling of the Salivary Glands may also cause ear pain.
The vagus nerve may mediate pain from the larynx, oesophagus, thyroid gland or bronchi.
Dissection or other disorders of the large arteries of the chest and neck may also cause ear pain through the sympathic nervous system.

In addition to examination of the ear, other parts of a regular otorhinolaryngological examination are to be carried out.
Palpation of the temporomandibular joints (the joint is felt at the orifice of the external acoustic meatus while the patient opens and closes his/her mouth repeatedly)
Palpation of the neck
Orthopantomography in a prolonged condition, even if not all causes originating in the temporomandibular joint will be visualized by this method, e.g. dysfunction of the temporomandibular joint disc.

If the condition becomes chronic and the cause of pain remains unclear, a consultation with an ENT specialist is warranted. If the cause is suspected to lie in the temporomandibular joint or the dental occlusion, a dentist should be consulted.