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

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

Reference:

• (1) Rosenfeld RM, Schwartz SR, Cannon CR, et al. Clinical practice guideline: acute otitis externa.Otolaryngol Head Neck Surg2014;150(Suppl):S1-24.doi: 10.1177/0194599813517083
• (2) Sander R. Otitis Externa: A Practical Guide to Treatment and Prevention.Am Fam Physician 2001;63:927-36,941-2.