Otalgia is ear pain or an earache. Primary otalgia is from pain that originates inside the ear. Referred otalgia is from pain that originates from outside the ear.

Otalgia is not always associated with ear disease. It may be caused by several other conditions, such as impacted teeth, sinus disease, inflamed tonsils, infections in the nose and pharynx, and occasionally as a sensory aura that precedes a migraine.

The 2 common causes of otitis externa are trapped moisture and minor injury to the ear canal. Otitis media is caused by bacteria growing in the middle ear behind the eardrum. It often follows a cold or upper respiratory tract infection. There are other risk factors identified with increased frequency of otitis media.
•    Risk factors of otitis externa
o    Moisture trapped in the ear canal

• The condition commonly called swimmer's ear can occur after swimming or bathing or sometimes just from hot humid weather.

• Bacteria that cause the infection are able to grow and multiply easily in the warm moist environment.

o    Minor injury or scrape to the ear canal skin

• This usually happens during attempts to clean the ear with objects, such as a cotton-tipped swab or paper clip.

• The break in the skin allows bacteria to penetrate and start an infection.

•    Risk factors of otitis media
o    Cold or upper respiratory tract infection

• These conditions cause swelling at the back of the nose where the ear normally drains. The ear is connected to the nose by the Eustachian tube.

• If the eustachian tube does not function properly, fluid can become trapped behind the eardrum (serous otitis media). If bacteria grow in that fluid, then infection occurs (otitis media).

•    Ear infection
o    Middle ear infection - acute (short and severe episode)
o    Middle ear infection - chronic (does not go away or recurs)
o    Outer ear (canal) infection - acute
o    Outer ear (canal) infection - chronic

• Outer ear (canal) infection - malignant

o    Allergies
o    Daycare
o    Secondhand smoke exposure
o    Bottle (rather than breast) feeding
o    Family history of ear infections
o    Malformations of the head and neck area

•    Otitis externa
o    Typically, there is an earache, which can be severe.
o    Mild cases may have more of an itch than pain.
o    Touching or pulling on the ear worsens the pain.
o    Hearing loss
o    Ringing or buzzing sounds in the ear
o    Blocked or full sensation in the ear
o    Swelling of the ear
o    Thick drainage from the ear

•    Otitis media
o    Pain in the ear (most common symptom)
o    Hearing loss
o    Ringing or buzzing sounds in the ear
o    Full or plugged sensation in the ear
o    Fever
o    Occasionally, discharge from the ear (eardrum ruptures and the infected fluid drains out)
o    Other symptoms in infants

• Vomiting or diarrhea
• Irritability
• Poor feeding
• Poor sleeping

Various tests are used in the diagnosis of Earache. Some of these are listed below:

•    General observation
o    Observe the person's general state and behavior e.g. sudden, jabbing pain may indicate trigeminal neuralgia or glossopharyngeal neuralgia

•    Physical examination
o    Manipulate the pinna to establish if this aggravates the pain - would suggest otitis externa, foreign body, impacted wax, furunculosis, ear lobe infection or perichondritis.
o    Examine the skin of the pinna for pathology such as skin tumor
o    Examine for enlargement of the local lymph nodes
o    Examine the nature of the ear discharge - if present.

•    Otitis externa
o    Most cases are treated with eardrops for 7-10 days.
o    These drops contain antibiotic to fight the infection and, sometimes, a steroid to reduce swelling.
o    The drops are placed in the ear while the person is lying on his or her side, with the affected ear up.
o    The outer ear is gently pulled backwards, and the drops are placed over the opening to the ear canal.
o    The ear is gently wiggled for a minute to help the drops penetrate.
o    The person should remain in this position at least 5 minutes. Then a cotton ball can be placed over the ear to catch any spill.
o    Sometimes a wick is placed in the canal if swelling is severe.
o    Some severe cases will require an oral antibiotic as well as the eardrops.
o    The person may require strong pain medication for the first few days.
o    During treatment and for 1-2 weeks after treatment, water should be kept out of the ear.
o    Either an earplug or small cotton ball coated with Vaseline can be used during bathing.
o    In some cases the drainage in the ear builds up, and the infection won't clear until it is removed. An otolaryngologist (an ear, nose, and throat specialist), using special equipment, usually will remove this build-up
.
•    Otitis media
o    Most cases are treated with an oral antibiotic for 10-14 days.
o    In some cases a decongestant medication is helpful.
o    Pain medication may be needed for the first few days

The following steps can help prevent earaches:

•    Avoid smoking near children. Smoking has been shown to cause millions of ear infections each year in children.
•    Prevent outer ear infections by not putting objects in the ear, and drying the ear after bathing or swimming.
•    Take steps to control allergies. In particular, avoid allergy triggers. Steroid nasal spray may help reduce ear infections. However, over-the-counter sedating antihistamines and decongestants do NOT prevent ear infections