OTALGIA

• Otalgia, or pain localised to the ear
• Various diseases can cause otalgia because the ear has rich sensory innervations through many cranial (V, VII, IX, and X) and cervical (2 and 3) nerves
• Otalgia can be classified as primary or referred
• Otogenic otalgia originates from diseases of the external, middle and inner ear
• Referred otalgia arises from pathologies outside the ear

Otogenic otalgia may be due to infection, inflammation, mechanical causes, neoplasm, or Eustachian tube dysfunction

Infectious

• Furunculosis
• Infected sebaceous cysts
• Cellulitis
• Otitis externa
• Necrotizing otitis externa
• AOM
• Mastoiditis
• Bullous otitis externa
• Bullous myringitis

Inflammatory causes

• Chondro dermatitis
• Relapsing polychondritis

Mechanical causes

• Traumatic laceration
• Pinna haematoma
• Tympanic membrane perforation

Neoplastic causes

• Squamous cell carcinoma
• Adeno carcinoma

Eustachian tube dysfunctions

• Otitis media with effusion
• Chronic otitis media

Referred otalgia is associated with the nerve affected

Auriculotemporal nerve (cranial nerve V)

• Temporomandibular joint dysfunction
• Dental diseases
• Trigeminal neuralgia
• Mandibular osteomyelitis / tumour

Posterior auricular nerve (cranial nerve VII)

• Acoustic neuroma
• Herpes zoster infection.

Jacobson's nerve (cranial nerve IX)

• Tonsillitis/ pharyngitis
• Sinusitis
• Pharyngeal tumour
• Glossopharyngeal neuroma

Arnold's nerve (cranial nerve X)

• Laryngopharyngeal reflux
• Cricopharyngeal spasm
• Vagal stimulators.

Greater auricular (C2) and lesser occipital (C3) nerves

• Cervical spine degenerative disease
• Cervical root cysts
• Vascular diseases
• Fibromyalgia
• Psychogenic causes

Primary otalgia

• Otorrhea
• Tympanic membrane fullness
• Vertigo

Secondary otalgia

• Pain with chewing
• Sinusitis
• Pain from dental procedures
• History of gastroesophageal reflux - suggest secondary otalgia

• Consider - pain location, duration, aggravating factors, alleviating factors, associated symptoms, previous episodes, medical history, smoking status, and alcohol abuse
• Inspection and palpation of the oral cavity and oropharynx with concentration given to the teeth, TMJ, tongue, soft palate, posterior pharyngeal wall and tonsils
• Opening and closing the mouth may reveal trismus, as well as audible or palpable crepitus suggestive of a TMJ abnormality
• Inspection of the auricle and periauricular region, as well as an otoscopic examination to visually inspect the tympanic membrane and the external auditory canal
• Ear swabs should be done only for recurrent or chronic otitis externa
• Hearing tests should always be considered for patients with associated hearing loss
• Imaging is performed when a patient is considered to be at high risk of malignancy

Treating common infections

Ayurvedic Treatment

To relieve infection

• Pancha thiktaka kashaya
• Guggulu panchapalam
• Kaisora guggulu
• Maha tikthaka gritha
• Guggulu thikthaka gritha

For Associated Respiratory tract infections

• Dashamoola katutraya Kashaya
• Vyoshadi vataka

Procedures

• Kabala – Triphala kashaya + Trikatu choorna
• Karna dhoopana – Guggulu varthi , Haridra
• Lepa - Rasnajambeera around ears and TMJ
• Jaloukavacharana - over ear