The painful ear

Otalgia, or ear pain, is a common presentation in general practice. It can be broadly divided into primary and secondary otalgia. Primary otalgia is pain that arises from pathology of the external, middle and inner ear. Secondary otalgia, or referred otalgia, is pain that arises from pathology outside the ear. There are many causes of secondary otalgia, due to the complex sensory innervation of the ear. History and physical examination are vital in determining the aetiology. This clinical review discusses the possible causes of ear pain, and provides a systematic approach to assessment and management, including when to refer to specialists.