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
- 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)
- 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
- 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
- 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
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