Eric L. Slattery, Timothy E. Hullar, and Lawrence R. Lustig

Referred otalgia is more vexing to diagnose and treat than primary otalgia because its source is often not obvious. It may require imaging, endoscopy, or a trial of empiric treatment. It is crucial not to miss a pharyngeal cancer presenting as referred otalgia.

Dental Sources

Pathologic processes affecting the teeth and gums are a common cause of referred otalgia. Examples include dental caries, periodontal infection, impacted teeth, dental injury, and ill-fitting dentures.

Pharyngeal Sources

The vagus nerve innervates a portion of the auricle, as well as the pharynx and larynx, so that pathologies in the pharynx and larynx may lead to referred otalgia. In fact, in some cases, a patient will have almost no symptoms at the site of the primary problem and will have only ear pain. Refer to the specific chapters on the oral cavity and throat pain for additional discussion of the pathologies listed below, all of which can present with significant referred otalgia:

Pharyngitis

Peritonsillar abscess

Laryngitis

Gastroesophageal reflux disease

Neoplasms: oral cavity, pharynx, and larynx (see sections VI and VII)

Tonsil neoplasm