CAUSE FOR EAR ACHE IN A NORMAL EAR

Sometimes you go to an ENT doctor  for earache and the doctor will say your ear is normal. Won't you be confused ?  Yes this condition is known as REFERED  OTALGIA or  REFERED EARACHE. Few days back a patient asked me the same question, he was having  some lesions on his uvula (part of oropharynx) and was experiencing earache . 

WHY IS IT SO ? 

Referred  earache is caused by the nerves, which are sensory (sensation). Few cranial nerves ( arising  from brain) and few cervical ( spinal) nerves  innervate the ear and other structures  equally , so when there is a pathology  ( inflammation or any lesion) on that part, the ear👂 also will experience that pain which is REFERED from the other area. 

MECHANISM

The FIFTH cranial nerve   (trigeminal)  branches into THREE ( am  not going to explain the anatomy in detail as this post is mainly for nonmedicos) and supply upper, middle and lower part of the face and other structures   including a part of the ear. 

The THIRD division of the nerve carries sensation  from anterior ( front) two third of the tongue, floor and roof ( palate) of the mouth, lower teeth, TMJ ( jaw joint) , lower jaw bone and  salivary glands ( which  produce saliva). Any pathology or inflammation in these areas will cause earache as the external ear canal is also supplied by one of its branches. 

Sensory part of SEVENTH cranial  nerve innervates POSTERIOR  (back portion)  and nasal cavity and sphenoid sinus along with the ear. 

NINETH  cranial  nerve  innervates posterior ( back) one third of the tongue, tonsils, nasopharynx ( back of the nose), hypopharynx( part of pharynx near sound box or upper airway structures), parapharyngeal ( side of the pharynx) and retropharyngeal  ( back of the pharynx) spaces along with the ear. 

TENTH cranial nerve supplies vallecula ( behind the tongue) supraglottis( upper part of the larynx or airway) thyroid gland, tracheobronchial tree and esophagus ( food pipe). 

CERVICAL nerves (upper part) supplies muscles and facet joints of cervical region (  back of the neck) along with a part of the ear. So neck muscle spasms or joint problems can cause refered earache. 

CONDITIONS THAT CAUSE REFERED EARACHE

Acute ( sudden onset) tonsillitis, ulcers, injuries  ( ulcer) or cancer  ( late stage in some cases) of oral cavity and oropharynx   like lips, gums, buccal mucosa ( inner lining ) , tongue, uvula and pharynx. 

LPR( laryngopharyngeal reflux), stylalgia( enlargement of a bone ) 

Neck, any pathology in the upper cervical spine, neck muscles can manifest as earache

 Nasal pathologies, Sinusitis, Nasopharyngeal cancers  and other pathologies can cause earache.

 TMJ   and dental  problems can also cause earache

These are some of the causes for referred otalgia( earache)  and other symptoms  and signs will be there, so the source  can be identified. 

WHENEVER YOU HAVE EARACHE AND YOUR EAR IS NORMAL,THESE ARE THE AREAS TO LOOK AT. 

Hope this post was useful.