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.
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