Compare and contrast the causes of otalgia including lesions of the pinna, external auditory canal, middle ear and referred pain. PRIMARY OTALGIA CAUSES WITHIN THE EAR Otitis media Otalgia/earache followed by discharge Hearing loss Fever Mastoiditis -> rare complications. Physical examination findings: Bulging to the tympanic membrane. Loss of light reflex. Retracted and hypomobile TM Purulent/serosanguineous discharge Distinct erythema External otitis Initial symptoms: Itch Discharge Following symptoms: Pain -> severe and especially at night. Reduction in hearing as the ear canal closes off. Examination features: Debris in the canal -> needs to be removed either by gentle mopping or preferably by suction. Folliculitis Cerumen impaction Buildup of cerumen in the external auditory canal -> prevents clinical evaluation of the auditory canal, tympanic membrane and/or the audio vestibular system. Clinical features: Ear discomfort -> feeling of fullness, itching and pain. Otorrhea. Odor/ Hearing loss -> conductive hearing loss -> decreased hearing aid performance. Nonspecific symptoms: Speech delay Behavioural changes Cognitive decline Cough Vestibular symptoms (uncommon) -> tinnitus and vertigo. Fings in otoscopy Tightly packed cerumen in the outer ear canal that partially or completely obstructs visualisation of the auditory canal and/or the tympanic membrane. Mastoiditis Tender and erythematous mastoid. Lateral or forward ear displacement. Due to swelling behind the ear that can cause the ear to stick out. Pain, soreness and tenderness behind the ear. Ear discharge Hearing loss in the affected ear. Myringitis Infection of the tympanic membrane Most commonly due to a viral or a bacterial infection. Sudden onset severe pain Fever Poor appetite. Hearing loss Fluid running from ears. Sensation of congestion. Physical examination findings: Vesicles and bullae. Neoplasms SECONDARY OTOALGIA REFERED PAIN Sinus issues Dental problems Temporomandibular joint dysfunction Cervical spine issues from C1 to C3. E.g. cervical osteoarthritis Tonsils and tongue base problems from CN IX (Jacobson’s nerve) nerve Larynx and pharynx from vagus (Arnold’s nerve) Mastoiditis Ramsay Hunt syndrome. Causes vesicles along the distribution of the CN VII. Eustachian tube dysfunction. Innervation of the pinna is from the auriculotemporal branch to the trigeminal nerve and the first two cranial nerves.