Otalgia is a common symptom in children presenting to general practitioners, paediatricians and otorhinolaryngologists. Although the causes are frequently otological in origin, one needs to be aware of the non-otological pathologies that can result in referred pain to the ear. Inflammatory and infective conditions of the middle ear are by far the predominant causes of primary otalgia in children. Non-otological origins of earache include oral, oropharyngeal, laryngeal, dentoalveolar, sinonasal and musculoskeletal pathologies (box 1).

MECHANISM OF OTALGIA

The human ear has numerous sensorineural supplies,1 which often explains the various types of referred earache. The great auricular, facial, lesser occipital, auriculo-temporal and vagus nerves innervate the external and middle ear. The great auricular nerve supplies the posterior part of the lateral surface of the pinna and most of its superior aspect, while the facial nerve supplies an area within the external auditory canal. The lesser occipital nerve supplies a small area at the tip of the helix. The auricular division of the auriculo-temporal nerve (a branch from the mandibular division of the trigeminal nerve) carries sensory impulses from the anterior part of the lateral surface of the pinna; its tympanic branches supply the anterior half of the external auditory meatus and the anterior segment of the tympanic membrane. The tympanic branch of the glossopharyngeal nerve carries sensory impulses from the middle ear cavity, which explains why children suffering from tonsillitis and sore throat often complain of referred ear pain. A branch of the vagus nerve provides sensory supply to a part of the concha, the posterior part of the external auditory meatus and the posterior segment of the tympanic membrane. Inflammatory pathologies of the larynx, therefore, can be associated with otalgia.

EMBRYOLOGY OF THE EAR AND ITS CLINICAL RELEVANCE1

The pharyngeal …