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Other causes of otalgia or otorrhoea that may mimic acute otitis externa

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Other causes of otalgia or otorrhoea may mimic acute otitis externa (1,2)

Other causes of otalgia to consider include:

  • 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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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.


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