Ear pain DDx

Ear pain – Differential Diagnosis

Common causes

• Infections
  • Otitis media
  • Otitis externa
  • Pharyngitis
  • Tonsillitis
  • Boils and furuncles
  • Sinusitis
• Ear wax
• TMJ syndrome
• Trauma
• Trigeminal Neuralgia
• Dental causes

Must Not Miss

• Tumour
  • Acoustic neuroma
  • Cholesteatoma
  • Nasopharyngeal cancer
  • Thyroid cancer
• Temporal arteritis
• Mastoiditis
• Malignant otitis externa
• Meningitis
• Coronary disease
• Thoracic aneurysm

Easily missed

• Psychogenic
• GORD
• Salivary gland disorder
• Bell’s palsy
• Cervical disc disease
• Ramsey Hunt syndrome

Red flags

• Meningism
• Acute sudden hearing loss
• Vertigo/ tinnitus
• Persistent discharge (especially in Diabetics)
• Facial nerve palsy
• Recurrent attacks of otitis media in adults
• Hoarseness
• Dysphagia

Investigations to consider

• FBC, CRP/ESR
• Swab
• Biopsy
• Skull X-ray
• CT scan/MRI