other causes of otalgia or otorrhoea that may mimic acute otitis externa
Last edited 04/2021 and last reviewed 09/2022
Other causes of otalgia or otorrhoea that may mimic acute otitis externa (1,2)
Other causes of otalgia to consider:
- furunculosis
- is the presence of an infected hair follicle on the
outer third of the ear canal, sometimes referred to as localized
otitis externa (1)
- clinical findings can include otalgia, otorrhoea,
localized tenderness, focal swelling, and pustular lesions
- clinical findings can include otalgia, otorrhoea,
localized tenderness, focal swelling, and pustular lesions
- is the presence of an infected hair follicle on the
outer third of the ear canal, sometimes referred to as localized
otitis externa (1)
- viral infections of the external ear
- caused by varicella, measles,
or herpes virus, are rare but are important on the differential
of AOE (acute otitis externa)
- caused by varicella, measles,
or herpes virus, are rare but are important on the differential
of AOE (acute otitis externa)
- complaints of otalgia in the absence of swelling of the ear
canal and without apparent middle ear disease should arouse the
suspicion of pathology outside the ear
- temporomandibular
joint (TMJ) syndrome may cause referred otaliga
- commonly complain of pain not only in the ear but also radiating to the periauricular area, temple, or neck
- may be a history of gum chewing, bruxism, or recent dental procedure with subsequent malocclusion
- examination findings may include tenderness over the affected
TMJ and may have associated crepitus
- temporomandibular
joint (TMJ) syndrome may cause referred otaliga
- upper aerodigestive tract cancer
- occasionally symptom is that of otalgia
- consider the possibility if otalgia in an older patient with a long history of
tobacco and ethanol use, and more recently younger patients
with human papillomavirus infection, suggest this possibility
- other causes of otalgia that should be considered and include (1):
- dental pathologies (caries, impacted molars),
- tonsillitis,
- peritonsillar abscesses,
- retropharyngeal abscesses,
- carotidynia,
- styloid process elongation,
- angina,
- intrathoracic aneurysms,
- glossopharyngeal neuralgia,
- and geniculate neuralgia
Other causes of otorrhoea to consider:
- otorrhoea may accompany AOE
- other causes of
otorrhoea should be considered in the differential diagnosis
- cholesteatoma
- may be mistaken for AOE or chronic external otitis but is typically painless and associated with abnormalities of the tympanic membrane that include perforation, retraction pockets, and granulation tissue
- if there is a suspected suspected cholesteatoma then should be referred to an otolaryngologist for definitive management
- cholesteatoma
- other causes of
otorrhoea should be considered in the differential diagnosis
- acute otitis media (AOM) with tympanostomy tubes
- is a common cause of otorrhoea
- is painless at first and caused by either a primary bacterial AOM episode or by water penetration into the middle ear from swimming or bathing
Reference:
- (1) Rosenfeld RM, Schwartz SR, Cannon CR, et al. Clinical practice guideline: acute otitis externa.Otolaryngol Head Neck Surg2014;150(Suppl):S1-24.doi: 10.1177/0194599813517083
- (2) Sander R. Otitis Externa: A Practical Guide to Treatment and Prevention.Am Fam Physician 2001;63:927-36,941-2.