Managing otalgia in general practice

Otalgia, also known as earache, can affect any age group and is a troublesome condition that is a frequent cause of visits to GP surgeries and walk-in centres. There are a variety of causes, the majority of which are benign conditions that can be easily treated; however, there are a few more sinister diagnoses that need to be considered in some cases.

Otalgia is generally classified as either primary, when pain originates in the ear itself and is more common in children, or secondary, occurring as a result of referred pain arising from a problem elsewhere, the latter more frequently seen in adults (Earwood et al, 2018).

A thorough history is needed to guide clinicians towards making an accurate diagnosis. A detailed history of the degree and severity of pain, any discharge from the ear (otorrhea), hearing loss, vertigo, tinnitus, or a feeling of fullness in the ear, together with duration of symptoms, is vital as part of the initial assessment. The time frame of symptom onset is important, as, generally, shorter time frames suggest a primary or benign cause and longer time frames may indicate a secondary cause (Harrison and Cronin, 2016). If the history is vague or does not suggest an immediate reason for the patient's symptoms, then more information should be sought to determine an alternative cause. History should then focus on symptoms relating to the other anatomical regions supplied by the same nerves innervating the ear, such as oral and dental problems, tonsillitis, and nasal and sinusitis problems (Harrison and Cronin, 2016). Red flags are shown in Table 1.