64 Otalgia

Otalgia is pain in the ear (earache). It is a symptom not a diagnosis. It may be caused by primary disorders of the ear (otological in origin) or may be secondary to disease from other sites in the head and neck, which share the same sensory innervation (referred pain). Otalgia is a common symptom presenting to the ENT clinic. It is therefore vital that one has a good understanding of the causes, a thorough method of assessment and a knowledge of the appropriate management of these patients.

64.1 Anatomy

The sensory nerve supply of the external and middle ears arises from several sources:

• The lower half of the pinna receives its sensory supply from the great auricular nerve via the cervical plexus, predominantly C2 and C3.

• The upper half receives its supply from the lesser occipital nerve (C2) medially and the auriculotemporal nerve laterally (mandibular branch of fifth cranial nerve).

• The external auditory meatus and lateral tympanic membrane receive their supply from the auriculotemporal nerve and auricular branches of the facial and vagus nerves (Arnold’s nerve, named after Friedrich Arnold, 1803–1890, Professor of Anatomy at University of Heidelberg).

• The medial aspect of the tympanic membrane and middle ear is supplied through the tympanic plexus by the facial nerve (nervus intermedius, which contains a sensory branch from the geniculate ganglion and also parasympathetic fibres from the superior salivary nucleus) and glossopharyngeal nerve (Jacobsen’s nerve, which contains not only sensory fibres from cranial nerve [CN] IX but also parasympathetic fibres from the inferior salivary nucleus). Remember that the lesser (sometimes and equally correctly called the superficial) petrosal nerve is a branch of the tympanic plexus which collects all the parasympathetic (secretomotor) fibres of the tympanic branches of the facial nerve (nervus intermedius) and Jacobsen’s nerve to relay in the otic ganglion for the secretomotor supply of the parotid gland and minor salivary glands of the vestibule of the mouth.

64.2 Primary Otalgia

Primary otalgia arises because of direct stimulation of the sensory nerves due to otogenic pathology. The pain may emanate from the pinna, the external meatus or middle ear.

• Pinna: haematoma, perichondritis, lacerations, neoplasms and chondrodermatitis nodularis helicis.

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