What Are the Most Common Causes of Outer Ear Pain?

Ear pain (otalgia) is a common symptom, which can be divided into three types: otogenic ear pain, reflex ear pain, and neurological ear pain. Otogenic ear pain, also known as primary ear pain, refers to ear pain caused by ear lesions. Reflex ear pain, also known as secondary ear pain, is because the nerves that govern the ears also control the sensations in other parts, so pain caused by lesions in other parts can be reflected to the ears through the nerve to cause ear pain. Neurotic ear pain is pain caused by a change in the sensory nerves of the ear. If dizziness, ear pain, tinnitus, hard of hearing and other symptoms occur, early diagnosis and treatment should be checked and applied to improve blood circulation and promote neurotrophic metabolism. Hyperbaric oxygen therapy can also be used if necessary.

Basic Information

English name

otalgia

Visiting department

ENT

Common locations

ear

Common causes

Ear ear lesions, ear shingles, external ear canal obstruction or foreign bodies, external ear canal diseases such as external ear canal inflammation, periosteum damage, middle ear diseases such as otitis media

Causes of ear pain and common diseases

External ear disease

(1) Traumatic trauma External forces can cause auricular hematoma or lacerations. Auricular hematomas often occur on the dorsal side of the auricle, with localized pain and severe pain after secondary infection.

(2) Auricular chondritis, serous chondritis, effusions under the cartilage in the ear cavity or in the cartilage, are generally not painful or have only slight tenderness. Purulent chondritis, inflammation of local redness and swelling, severe pain.

(3) Ear shingles, also known as BamsayHunt syndrome, has severe ear pain when it develops. There are three types of disease. Herpes simplex first has ear discomfort or burning sensation, followed by ear pain, redness and swelling of the skin of the auricle and external auditory canal, and herpes on the local skin after 3 to 5 days. Herpes mainly appears on the concave surface of the auricle, occasionally in the external auditory canal, scabs after a few days, and heals about a week later. Herpes complicated with facial nerve damage, in addition to sores and herpes, there is also ipsilateral peripheral facial paralysis. Facial palsy typically occurs about a week after the appearance of cancer herpes. Herpes complicated with facial nerve and auditory nerve lesions, in addition to involving the geniculate ganglion, at the same time damage the auditory nerve with tinnitus, sensorineural hearing loss and dizziness. This type is more serious, suggesting that the lesion is located in the labyrinth of the facial nerve.

Glossopharyngeal herpes or vagus ganglion herpes can be accompanied by ear pain, but without facial paralysis. Glossopharyngeal nerve herpes has no ear lesions, and herpes appears in the soft palate and tonsils. With vagal ganglion neuropathy herpes, the herpes is located in the posterior ear groove and the posterior wall of the external ear canal. Cervical nerve herpes of the first and second can also cause ear pain, severe pain, confined to the mastoid area. Herpes is located on the convex surface of the auricle and on the skin of the neck.

(4) External ear canal embolism or foreign body can compress the ear canal skin or tympanic membrane, especially when the water swells and the pain is severe.

(5) Ear canal is an acute purulent inflammation of the skin follicles or sebaceous glands of the external auditory canal, which easily occurs in the cartilage of the ear canal. Local swelling and tenderness. Spontaneous severe pain, especially at night or when chewing.

(6) Acute diffuse external auditory canalitis is a widespread purulent infection of the external auditory canal skin. There are obvious spontaneous pains and auricle stretch pain or tragus tenderness.

(7) Necrotizing external auditory canalitis is also called malignant external auditory canalitis. This disease occurs in patients with diabetes, so it is also called diabetic external auditory canalitis. The pathogenic bacteria are Pseudomonas aeruginosa. Ear canal necrosis quickly spreads to the surroundings, and can be complicated by mastoiditis, skull base osteomyelitis, meningitis, and sepsis.

Middle ear disease

(1) The most common cause of tympanic trauma is a sudden increase in pressure in the external auditory canal, such as knocking, slapping, diving, etc. In addition, the tympanic membrane can be damaged because the eustachian tube is blown too hard and the instrument is too deep when taking foreign objects. When the tympanic membrane is ruptured, there is temporary tearing pain, hearing loss, dizziness, and tinnitus.

(2) Sudden stinging occurs suddenly after bullous tympanitis. Examination revealed bloody blisters in the external ear canal and tympanic membrane, which healed in a few days.

(3) Acute suppurative otitis media Ear pain is one of the main symptoms of acute suppurative otitis media and is often a complication of upper respiratory infections. Sudden onset of illness, severe cases have unbearable stinging, jumping pain. After the secretion of the middle ear from the tympanic membrane perforated, the pain is reduced. Because this disease is often accompanied by the inflammatory response of the mastoid periosteum, tenderness and tenderness in the mastoid area are often present. If the pain in the middle ear does not abate, the possibility of acute mastoiditis should be considered.

(4) Chronic suppurative otitis media with acute episodes of chronic bone ulcer or cholesteatoma type otitis media, such as poor drainage of pus, acute onset, ear pain with headache, fever, suggesting that intracranial and extracranial complications will occur.

(5) Barometric traumatic otitis media In the case of sudden changes in barometric pressure such as rapid flight or diving at high altitude, barotrauma can occur with ear pain, tinnitus and hearing loss.

(6) Middle ear cancer is mostly based on chronic suppurative otitis media, with only initial pain, advanced persistent dull pain, bloody secretions in the ear canal, and prominent granulation, which is brittle and easy to bleed.

(7) Bell's facial paralysis is a peripheral facial paralysis of unknown cause. Often a few hours before the appearance of facial paralysis, deep dull pain in the area behind the ear first appears, followed by facial paralysis. The pain usually lasts for several days.

3. Reflex ear pain

(1) Trigeminal nerve

1) When the maxillary branch has acute sinusitis, it can cause reflex ear pain through this branch.

2) The nerves that can cause reflex ear pain in the mandibular branch are: The tongue nerve. Inferior alveolar nerve. Temporal Auricular Branch.

(2) The glossopharyngeal nerve supplies the sensation of the posterior wall of the pharynx, including the top of the nasopharynx, down to the epiphyseal wrinkles, the tonsils and the posterior third of the tongue. Acute inflammation of the tonsils, nasopharyngeal cancer, malignant tumors behind the tongue 1/3, piriform fossa cancer, etc., ear reflex pain may be the initial symptoms.

4. Neurogenic ear pain

Neurological earaches are mainly viral neuritis, rheumatic neuritis, etc. involving the geniculate ganglion, semilunar ganglia, second and third cervical nerves, glossopharyngeal ganglia, and vagus nerve. More common is otic herpes zoster caused by gangliovirus infection, and severe pain occurs in the running part of the affected nerve. Followed by the onset of glossopharyngeal neuralgia is often accompanied by ear pain.

Differential diagnosis of ear pain

External auditory canalitis

When the ear is uncomfortable, some people like to dig in the ear with nails, hairpins, etc. This can easily puncture the ear canal skin and cause infection and inflammation. At this time not only ear pain but also accompanied by bleeding.

2. External ear canal bloated

When external auditory canal is not treated in a timely manner, or is old and frail, suffers from diabetes, or the skin of the ear canal is immersed in water for a long time, and the skin surface resistance is weakened, the ear canal is often prone to bloating. Gradually swell and purify, blocking the ear canal, causing pain.

3. Acute otitis media

When bacterial infection occurs in the middle ear cavity, pus continuously increases and directly compresses the tympanic membrane that is sensitive to pain, which can cause bursts of pain in the ear and can be pulsating pain.

4. Ear herpes

Viral infections are more common on the auricle. The earaches caused by acupuncture or burning are a few. A few people may also have facial paralysis, hearing loss, nausea, and vomiting.

5. Ear owl

Commonly known as "ear wax", it is produced by the glandular glands under the ear canal skin. Accumulation can block the ear canal and hearing can be affected. Once water enters the ear canal, the bladder swells and tightly presses the ear canal to produce ear pain.

6. Ear tumor

When there is a malignant cancer in the ear canal or middle ear cavity, as the disease progresses, there will be ear canal bleeding and hearing loss, and there will be ear pains of varying degrees.

7. Ear neuralgia

There are many nerves around the ear, and when there is excessively strong or prolonged noise or unexplained stimuli, ear pains often appear, usually faint.

Ear pain check

Perform ear examinations in a timely manner.

Ear pain treatment principles

Adopt corresponding treatment measures according to different diseases.

If dizziness, earache, tinnitus, hard of hearing, etc. appear, treat them early.

The use of low-molecular-weight dextran, vitamin B ₁ , B ₁₂ , and salvia miltiorrhiza can improve blood circulation and promote neurotrophic metabolism. Hyperbaric oxygen can also be used when necessary.