Referred Pain in the Ear

Referred Pain in the Ear (Referred Otalgia)

Referred pain in the ear occurs when a pathology outside the ear causes pain perceived in the ear.

This is due to the shared sensory innervation of the ear with other anatomical regions through cranial and cervical nerves.

🧵 Nerve Supply of the Ear

The sensory innervation of the ear involves:

• Cranial Nerves:

  • CN V – Trigeminal nerve
  • CN IX – Glossopharyngeal nerve
  • CN X – Vagus nerve

• Cervical Nerves:

  • C2 and C3

These nerves also supply areas such as the oral cavity, pharynx, larynx, and cervical spine. Pathology in these areas can refer pain to the ear.

🎯 Causes of Referred Otalgia by Nerve Involvement

1. Trigeminal Nerve (CN V)

Involves structures from the oral cavity, teeth, and temporomandibular joint (TMJ).

➤ Dental Causes:

• Dental caries
• Impacted molars
• Malocclusion of teeth

➤ Oral Cavity Causes:

• Benign or malignant ulcerative lesions

➤ TM Joint Causes:

• TMJ arthritis
• Causton syndrome

1. Glossopharyngeal Nerve (CN IX)

Supplies the base of tongue, tonsils, and oropharynx.

➤ Causes:

• Base of tongue malignancy
• Acute tonsillitis
• Peritonsillar abscess
• Ulcers of soft palate or tonsil (benign or malignant)
• Eagle Syndrome

1. Vagus Nerve (CN X)

Innervates the larynx, pharynx, and has branches to the thyroid.

➤ Laryngeal Causes:

• Tuberculosis
• Carcinoma of larynx
• Ulcerative lesions

➤ Thyroid Causes:

• Acute or subacute thyroiditis
• Hashimoto's thyroiditis

1. Cervical Nerves (C2, C3)

Supply the neck and posterior scalp.

➤ Causes:

• Cervical spondylosis
• Caries spine

🧾 Summary of Sites and Nerve Supply

🧬 Neoplasms Causing Referred Otalgia

✅ Most Common Causes of Referred Otalgia

When ear examination is normal but the patient complains of ear pain, always suspect referred pain.

Common Causes to Rule Out:

• Dental caries
• Impacted molar
• Posterior tongue lesions
• Pharyngeal or tonsillar pathology

🩺 Clinical Relevance

Referred otalgia is a red flag symptom in ENT.

In any case of persistent ear pain with a normal ear examination, evaluate all potential sites of referred pain, especially the oral cavity, pharynx, and cervical spine.