Authors: Miller DA, Wyrwa EB.
Title: Ear pain: a dental dilemma.
Journal: Compendium
Date: Aug 1992
Citation: 676, 678, 680 passim
Category: Diagnosis and Case Selection
Evidence-based Ranking: 5
Purpose/Objectives: To present cases that illustrate some of the different causes of otalgia that may be seen in the dental practice. Materials & Methods: This paper presents four case reports that deal with ear and facial pain and how the cases are diagnosed. One of the cases ended up being odontogenic in origin, two of the cases were diagnosed as otitis externa and the last was a combination of the two. The paper discusses how ear pain, or otalgia, can arise from otologic causes (otitis media, otitis externa, mastoiditis) as well as from nonotologic causes (odontogenic, tonsillitis, neoplasms, etc.). Nonotologic pain, or referred otalgia, is felt in or around the ear but actually originates from another site. This is thought to occur because of the convergence theory, or the convergence of a rich sensory nerve supply from the external and internal ear from several cranial nerves (V, VII, IX, X, C2, C3) on the subnucleus caudalis. It is thought that misguided afferent inputs, from an inflamed molar, for example, are mistakenly perceived in the cerebral cortex to have come from the ear. In cases where the dentist is unsure of the origin of pain involving the face/teeth/ear, it is recommended that thorough pulp testing be done as well as a quick, downward pull on the patientÂ’s earlobe. If this elicits pain, a diagnosis of outer ear pathology is likely and referral to a physician is indicated. Absence of this sign eliminates this possibility. ReviewerÂ’s Comments: This paper is a good review of the basics of otalgia, the convergence theory of pain, and steps to be considered when diagnosing pain related to the face, teeth and periauricular area.