Otalgia in adults: differential diagnosis in primary health care

Abstract

Otalgia is a common symptom that can be caused by pathology of the ear (primary otalgia) or by pathology of other anatomical sites that refer the pain to the ear (secondary otalgia). When making the differential diagnosis in primary care, it is useful to know that the most frequent causes of primary otalgia are otitis media and otitis externa, and in their absence, other frequent causes such as Eustachian tube dysfunction or barotrauma should be considered. On the other hand, secondary otalgia is more frequent due to dental causes, pharyngitis or tonsillitis, temporomandibular joint disorders, and neuralgia. Some etiologies of otalgia that merit urgent referral include temporal arteritis, infectious complications, and “even”, acute myocardial infarction. Cancer risk factors should always be considered, and a specialist should be consulted in case of suspicion or in case of persistent symptoms without a clear etiology.