Refers to earbpain and is commonly identified as primary when the pain originates from the ear.

When the source of the pain is from any site other than the ear it is classified as non-otogenic, secondary or ref2242ed otalgia.

Ear pain frequently associated with physical findings.

External ear pain may be secondary to otitis externa with pinna or tragus sensitivity.

External ear pain may be associated with impacted cerumen, foreign bodies in the external canal, trauma to the external canal,perichondritis, and myringitis.

The middle ear may cause ear pain with otitis media, eustachian tube dysfunction, barotrauma and mastoiditis.

Secondary ear pain, is non-otologic.

Cranial nerves III, VII, IX and X may be associated with ref2242ed pain from dental infections, temporal-mandibular joint syndrome, Shingles, tonsillits, GERD and thyroiditis.

Cervical nerve pain may be ref2242ed to the ear with neck infections, lymph node enlargement, cervical cysts, cervical spjne disorders, paranasal sinusitis, and migraine headaches.

Primary otalgia usually results from inflammatory, infectious, or neoplastic process of the external or the middle ear.

Derivative of the vagal nerve, cranial nerve X, Arnold’s nerve innervates the posterior inferior region of the external ear canal, adjoining part of the lateral tympanic membrane, and concha.

The upper cervical nerves C2 and C3 provide the greater auricular and lesser occipital nerves which innervate to the postauricular region, including the skin overlying the mastoid and parotid gland.

When no apparent evidence of ear disease is present with ongoing otalgia, ref2242ed Otalgia is to be considered.

Evaluation includes extensive examination of the head and neck region including endoscopic visualization of the nasopharynx, base of the tongue, larynx, and hypopharynx.

Because of shared sensory innervation with the ear the aerodigestive tract and thoracic structures should be evaluated in ongoing otalgia.

If preliminary examination is negative imaging with CT or MRI of the head and neck must be considered.

The ear is supplied by sensory innervation from cranial nerves V, VII, IX, and X, along with upper cervical nodes nerves C2 and C3.

The trigeminal nerve, cranial nerve V, innervated the anterior auricle, tragus, lateral surface of the tympanic membrane, and the anterior portion of the external auditory canal, principally via the auriculotemporal branch of the mandibular division.

Cranial nerve VII, the facial nerve, has a sensory innervation to the postauricular area, posterior auricle, and lateral surface of the external auditory canal via the posterior auricular nerve.

A branch of the glossopharyngeal nerve, cranial nerve IX (Jacobson’s nerve), travels to the eustation tube, middle ear, and inner surface of the tympanic membrane.

There are multiple potential disorders of ref2242ed otalgia and include:dental disease, temporomandibular joint dysfunction, trauma and degenerative disease of the cervical spine, head and neck neoplasms, myofascial pain syndrome, neuralgias, shingles, and GERD.

Dental disease causing ref2242ed ear pain from cranial nerve V is the most common source of ref2242ed pain accounting for 50 to 74% of cases via auriculartemporal branch of the nerve.

The mandibular molar teeth are the most commonly involved with otalgic pain.

Caries, abscesses and malocclusions secondary to the lack of dentition and or poorly fitting dentures constitute a majority of cases of otalgia from dental pathology.

Otalgia may result from oral ulcers, mainly in the posterior third of the tongue, tonsil lad area, and pharynx.

Occurs in greater than 70% of patients with temporomandibular joint dysfunction.

TMJ otalgia is severe with eating or passive movements of the mandible.

TMJ otalgia is due to muscle spasms involving muscles of mastication or intrinsic joint disease.

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