Ear ache (otalgia)
This nine-year-old girl was brought to the surgery with a history of a right-sided earache. It had woken her in the night. On examination, she was afebrile, and on auroscopy, the ear drum appeared normal and was not inflamed. Her general health was good and she had had no previous ear infections, but had been troubled by a 'cold and runny nose', with a clear nasal discharge, in the previous few days. The throat appeared normal and the regional lymph glands were not enlarged. About half of patients presenting with earache, without an underlying cause, resolve spontaneously and symptomatic treatment with an analgesic such as paracetamol or ibuprofen is sufficient. If an underlying cause is found, the appropriate treatment or antibiotic is indicated. If pain persists, the case should be reviewed within a few days. If a cause is not obvious, referral to a specialist may be advised to assess the possibility of a more serious cause such as malignancy, which can occur in both children and adults.