Otalgia (earache) is pain presented in the ear, which does not necessarily originate from the ear (primary otalgia). In the differential diagnostics of (secondary) otalgia cervicocephalic syndrome, temporomandibular disorders, odontogenic pathology, parotitis, tonsillitis, pharyngitis, epiglottis, oesophagitis and malignant tumours infiltrating trigeminal, vagal or auricular (cervical) nerves branches from oesophagus inferiorly and skull base cephalad, should be considered. Primary otalgia is usually confined to external otitis or acute otitis media, while it is rarely found as a symptom of chronic otitis media, except in exacerbations. In the chronic otitis media earache is usually a sign of complication and expansion of inflammation to the dura and cranial nerves.
In the differential diagnostics of primary otalgia otoscopy and otomicroscopy are necessary, as well as radiologic work-out, where CT and MRI scans are replacing former conventional x-.ray Schuller and Stenvers views. If otalgia is associated with hearing or balance disorders without clinical manifestation of otitis, the etiology is most commonly viral neuritis of temporal bone nerves, and otoneurological diagnostic workout should be considered. If (secondary) otalgia is associated with dysphagia or odinophagia, the most common etiology would be tonsillopharyngitis, but quinsy, epiglottitis, tongue base abscess, parapharyngeal abscess, and tumours of pharynx, tonsill or tongue base or epiglottis should be considered. Eagle syndrom or elonged styloid process syndrom is also characterised by painful swallowing and referred otalgia.
Earache can be caused by temporomandibular disorders, where otalgia is usually increased by mastication and joint palpation. The role of otorhinolaryngologist is to exclude otogenic and pharyngogenic otalgia, and the differential diagnostics should include workout considering cervicogenic otalgia (cervical spine x-ray or MRI), temporomandibular disorders (TMJ x-ray, dentist consultation), or odontogenic otalgia (dentist consultation). The diagnostic workout of otalgia should include radiologist, dentist, reumatologist, and neurologist.Otalgija je bol koja se prezentira u području uha, međutim to ne uključuje nužno otogenu etiologiju. U diferencijalnoj dijagnostici otalgije dolaze u obzir cervikocefalni sindrom, artralgija temporomandibularnog zgloba, odontogeni procesi, parotitis, tonzilitis, faringitis, epiglotitis, ezofagitis te maligni tumori s infiltracijom grana trigeminusa, vagusa i auricularis magnusa, koji se inferiorno šire do područja jednjaka, a kranijalno do lubanjske baze. Otogena bol najčešće se susreće u upalama vanjskog i srednjeg uha, dok je rijetka u kroničnim upalama, osim u fazama egzacerbacije. Kod kroničnih upala srednjeg uha, bol je znak komplikacije i širenja bolesti prema duri ili kranijskim živcima.
Za diferencijalnu dijagnostiku otogene boli nužna je otoskopija, katkad mikrootoskopija, te radiološka dijagnostika, ranije konvencionalne snimke temporalne kosti po Schulleru i Stenversu, koje danas sve više zamjenjuje CT i MRI. Ako je bol povezana s ispadom sluha ili ravnoteže, što je najčešće rezultat virusnog neuritisa u temporalnoj kosti, a bez kliničke manifestacije otitisa, u obzir dolazi i audiovestibulološka dijagnostika. Ako je otalgija povezana s disfagijom ili odinofagijom, najčešće je riječ o tonzilofaringitisu, ali u obzir dolaze i peritonzilarni apsces, epiglotitis, apsces korijena jezika, parafaringealni apsces, tumor ždrijela, tonzile, korijena jezika ili epiglotitis. Eaglov sindrom, sindrom elongiranog stiloidnog nastavka, također uključuje bolno gutanje i refleksnu bol u uhu.
Bolovi u uhu mogu biti uvjetovani temporomandibularnim poremećajima, s time da se otalgija pojačava žvakanjem ili palpacijom zgloba. Uloga otorinolaringologa jest isključiti otogenu ili faringolaringogenu otalgiju, a potom se diferencijalno dijagnostički uključuje obrada u smjeru cervikogene otalgije (radiološka obrada vratne kralježnice), artralgije temporomandibularnog zgloba (radiološka obrada zgloba, konzultacija stomatologa) ili odontogene otalgije (konzultacija stomatologa). U tome su smislu u obradu uključeni radiolog, stomatolog, reumatolog i neurolog
