Referred Pain in the Ear
💡 The post below is just an outline of the YouTube video and my notes. For the full content, please purchase the notes using the links above.
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
- 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
- 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
- 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
- Cervical Nerves (C2, C3)
Supply the neck and posterior scalp.
➤ Causes:
- Cervical spondylosis
- Caries spine
🧾 Summary of Sites and Nerve Supply
| Region Involved | Nerve Supply |
|---|---|
| Tonsils | CN IX |
| Oral cavity | CN V |
| Posterior tongue | CN IX |
| TM joint | CN V |
| Styloid process | CN IX |
| Larynx, pharynx | CN X |
| Thyroid | CN X |
| Parotid gland | CN IX |
| Spine (cervical) | C2, C3 |
🧬 Neoplasms Causing Referred Otalgia
| Cancer Type | Nerve Involved |
|---|---|
| Piriform fossa carcinoma | CN X |
| Glottic and supraglottic carcinoma | CN X |
| Post-cricoid carcinoma | CN X |
| Posterior pharyngeal wall CA | CN X |
| Posterior one-third tongue CA | CN IX |
| Nasopharyngeal and parotid CA | CN IX |
✅ 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.
📝 All the topics and questions mentioned in this post are explained in detail in my ENT notes - built for exam success and clinical understanding. Get full access by purchasing the notes.