Understanding Ear Pain - Otalgia (Innervation of ear, mechanism of ear pain and causes)

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Greek ōt- ‘ear’ + algos ‘pain’ means a painful ear. The ear is a structure that can be divided into 3 parts, inner, middle and external ear. Otalgia usually describes a painful ear caused by pathology in the external and middle ear. There are many sensory nerves which innervate the areas from the external ear to the middle ear. Many of these nerves also innervate other organs. Because of this pain in the ear may not be due to pathology in the ear but rather referred pain from inflammation elsewhere in the body.

In summary the auricle is affected by cranial nerves V3, VII, C2, and C3; the external auditory meatus and canal by cranial nerves V3, VII, and X and the middle ear including the tympanic membranes by cranial nerves X and IX. Irritation of any portion of these nerves can result in otalgia.

A good way to categorise otalgia is into primary and secondary Otalgia. Pain that originates from the ear is called primary otalgia, and the most common causes are otitis media and otitis externa which is much more common in children. Secondary otalgia is referred pain and is more common in adults.

Causes of primary Otalgia include acute otitis media which is an infection of the middle ear caused by bacteria and usually preceded by a viral infection. Pain is felt deep within the ear and children complain of non-specific symptoms such as irritability, poor sleep and feeding."

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