Ear pain

Ironically, the cause of this young man's ear ache is sinusitis.

Definition

Pain in the ear

Epidemiology

VERY common, especially amongst children.

Pathophysiology

There are two causes: pain in the ear, or referred pain from somewhere else.

Clinical and Associated Features

Ear cause

• Hearing loss
• Pus in ear
• Fever

Other cause

• Jaw pain
• Sore throat
• Tenderness on touching bone behind ear

Differential Diagnosis

Ear based

• Otitis media - infection of the middle ear. This is the most common cause, the classic ear infection, often caught after going swimming a lot. Commonly seen in children, less common in adults. Can be accompanied by hearing loss.
• Otitis externa - outer ear inflammation, often cause by eczema.
• Foreign body - kids love to stuff things in their ears. This can cause ear pain, or precipitate infection.
• Herpes zoster - shingles can cause ear pain.

Referred pain

• Tonsillitis
• Any cause of facial pain can present as ear pain, such as sinusitis and tempero-mandibular joint disorder.
• Tenderness of the bone behind the ear could be mastoiditis, a complication of otitis media, where the infection spreads to the bone. Rare now due to antibiotic use.
• Herpes zoster

Investigations

With most of these problems, you aren't going to bother with investigations. You will look in the ear, try to visualise the ear drum, and the back of the throat to check for tonsillitis.

Management

In otitis externa, a mild topical steroid should do the trick. In otitis media, they will probably need antibiotics. There is evidence that it might not do much, but at the moment, chuck 'em some amoxicillin.