Acute otitis media, otitis media with effusion
Chronic otitis media
External otitis or external canal pustule
Temporomandibular joint (TMJ) syndrome
Auditory (eustachian) tube dysfunction
Mastoiditis
Cerumen
Viral myringitis; Bullous myringitis
Dental causes: e.g. from caries/abscess, pulpitis, impacted third molars, etc.
Pharyngitis, Tonsillitis
Sinusitis
Oral aphthous ulcers
Barotrauma, Trauma
Foreign body
Idiopathic
Bruxism
Cervical spine arthritis
Cervical adenopathy
Cervical disc disease
Cellulitis, chondritis, perichondritis
Acoustic neuroma
Herpes zoster oticus (Ramsay-Hunt syndrome)
Myocardial infarction; Angina Pectoris
Nasopharyngeal tumor
Temporal arteritis
Cholesteatoma
Osteoma
Carotidynia
Gastroesophageal reflux
Tumors (ear, nasopharyngeal)
Bell’s palsy
Wegener’s granulomatosis
Ramsey Hunt syndrome
Relapsing polychondritis
Malignant external otitis
Coronary disease
Thoracic aneurysm
Psychogenic (depression, anxiety)
Thyroid tumor; Thyroiditis
Salivary gland disorder
Neuralgias (e.g., trigeminal, glossopharyngeal, geniculate, sphenopalatine)
Eagle’s syndrome
Myofascial pain, muscle spasm or inflammation of sternocleidomastoid or muscles of mastication
Primary carcinoma of the head and neck
Tumors or infected cysts in auricle or ear canal
Malignant (necrotizing) otitis externa
Relapsing polychondritis
Psychogenic causes (e.g., depression, anxiety)
Thinking through the Differential Diagnosis
Distinguish between true Otalgia vs. Referred Otalgia. True otalgia is ear pain that originates in the ear. Referred otalgia is pain felt in the ear but originating from a source outside the ear.
Further Reading
Schmerz. 1999 Dec 13;13(6):392-7. Differential diagnosis of otalgia. https://www.ncbi.nlm.nih.gov/pubmed/12799915
Am Fam Physician. 2008 Mar 1;77(5):621-628. Diagnosis of Ear Pain. https://www.aafp.org/afp/2008/0301/p621.html