16 Primary Otalgia

This chapter covers primary otalgia, which is ear pain caused by otologic disease. Many patients with ear pain have referred otalgia from another site, a topic which is covered in Chapter 17.

Auricular Origin

Chondritis

Chondritis is usually related to trauma or an inflammatory or infectious process. Traumatic chondritis is a common complication of burns and ear piercing, and the originating cause is usually obvious. Inflammatory chondritis may be related to an autoimmune disease, for example, relapsing polychondritis. It presents as part of a constellation of symptoms, with episodic hyperemia and edema of the auricle, nasal septum, and other cartilages (eg, larynx and trachea), and is associated with ocular inflammation, chronic malaise, arthropathy, and fever. Other inflammatory causes of chondritis are rheumatoid arthritis and polyarteritis. Infectious chondritis is often caused by penetrating trauma and is usually bacterial and caused by Pseudomonas. The lobule of the auricle is made up of fibrofatty tissue and skin, but has no cartilage; it thus is spared in patients with chondritis.

Cellulitis

Cellulitis of the auricle may be due to a specific traumatic event, or it may arise without a definable cause. An inciting cause could include a laceration, contusion, burn, or even frostbite. The skin of the auricle, including the lobule, may be edematous and erythematous, and the auricle is painful. Regional lymphadenopathy can also develop.

Herpes Zoster Oticus (Ramsay Hunt Syndrome)

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