What are the common causes of sharp ear pain. How can you identify and treat different types of ear discomfort. When should you seek medical attention for ear pain. What are the best prevention methods for ear-related issues.

Understanding the Anatomy of Ear Pain

Ear pain, medically known as otalgia, can be a distressing experience. It’s crucial to understand that not all ear pain originates from within the ear itself. Primary otalgia refers to pain stemming from the ear, while secondary otalgia describes pain that originates elsewhere but is felt in the ear. This distinction is essential for proper diagnosis and treatment.

The ear is a complex organ with several interconnected parts. The outer ear, middle ear, and inner ear all work together to process sound waves and maintain balance. When any part of this delicate system is disrupted, it can result in sharp or dull pain, along with other symptoms.

Key Components of the Ear

• Outer ear: Includes the visible part (pinna) and the ear canal
• Middle ear: Contains the eardrum and three tiny bones (ossicles)
• Inner ear: Houses the cochlea and vestibular system
• Eustachian tube: Connects the middle ear to the back of the throat

Pressure Changes and Ear Barotrauma

One common cause of sharp ear pain is pressure changes, which can lead to a condition called ear barotrauma. This occurs when there’s an imbalance between the air pressure inside and outside the ear, often due to rapid altitude changes or blockages in the Eustachian tube.

Symptoms of ear barotrauma may include:

• A feeling of fullness or pressure in the ear
• Sharp or dull ear pain
• Temporary hearing loss
• Dizziness or vertigo

Is ear barotrauma serious? While often temporary and resolving on its own, severe cases can lead to complications such as eardrum rupture. If symptoms persist or worsen, it’s advisable to consult a healthcare professional.

Sinus Infections and Their Impact on Ear Health

The intricate connection between the sinuses and ears means that sinus infections can often manifest as ear pain. There are three primary types of sinus infections that can affect the ears:

1. Otitis: Infection and inflammation of the ear
2. Mastoiditis: Infection of the mastoid bone behind the ear
3. Sinusitis: Inflammation of one or more paranasal sinuses

These infections can be either viral or bacterial in nature. Otitis, particularly otitis media (middle ear infection), is the most common type and often affects children more frequently than adults.

Recognizing Sinus-Related Ear Pain

How can you tell if your ear pain is related to a sinus infection? Look for these additional symptoms:

• Nasal congestion or discharge
• Facial pressure or pain
• Headache
• Reduced sense of smell
• Fever (in some cases)

Ear Infections: A Common Culprit for Sharp Pain

Ear infections are among the most frequent causes of ear pain, especially in children. These infections can affect either the inner or outer ear, each with its own set of characteristics.

Inner Ear Infections

Inner ear infections typically involve the Eustachian tube and are often viral in nature. They’re more common in children due to the shorter, more horizontal orientation of their Eustachian tubes.

Outer Ear Infections

Also known as swimmer’s ear, outer ear infections affect the ear canal. They’re usually caused by water or foreign objects irritating the ear canal, creating an environment conducive to bacterial growth.

What are the telltale signs of an ear infection? Be on the lookout for:

• Difficulty hearing or muffled sounds
• A feeling of fullness in the ear
• Discharge from the ear
• Itchiness or irritation in and around the ear
• Fever
• Low energy or fatigue

Temporomandibular Disorder: When Jaw Problems Cause Ear Pain

Temporomandibular disorder (TMD) is a condition affecting the joints that connect the jawbone to the skull. While primarily a jaw issue, TMD can cause pain that radiates to the ears, often mimicking ear-specific problems.

Can TMD really cause ear pain? Yes, due to the close proximity of the jaw joint to the ear, pain from TMD can often be felt in or around the ears.

Identifying TMD-Related Ear Pain

To distinguish TMD from other causes of ear pain, look for these accompanying symptoms:

• Clicking, popping, or grinding noises when moving the jaw
• Difficulty opening the mouth fully
• Jaw locking when opening or closing the mouth
• Pain that worsens when chewing or yawning

While TMD can be uncomfortable, it’s usually not serious and often improves on its own or with conservative treatments.

Foreign Objects in the Ear: A Surprising Source of Pain

Sometimes, sharp ear pain can result from a foreign object lodged in the ear canal. This is particularly common in children, who may insert small objects out of curiosity.

What should you do if you suspect a foreign object in the ear? Resist the urge to remove it yourself, as this could push the object further into the ear canal. Instead, seek professional medical help.

Symptoms of a Foreign Object in the Ear

• Sharp or dull pain
• Drainage from the ear
• Hearing loss
• Sensation of fullness in the ear
• Possible infection if left untreated

Healthcare providers have specialized tools and techniques to safely remove objects from the ear canal without causing further damage.

Associated Symptoms and When to Seek Medical Attention

While ear pain itself can be concerning, certain associated symptoms may indicate a more serious condition requiring prompt medical attention.

When should you consult a doctor for ear pain? Consider seeking medical help if you experience:

• Sudden, severe hearing loss
• Persistent tinnitus (ringing in the ears)
• Loss of balance or vertigo
• Facial nerve paralysis
• High fever accompanying ear pain
• Pain that persists for more than a few days

These symptoms could indicate more severe conditions such as Ménière’s disease, acoustic neuroma, or complications from untreated infections.

Treatment Options and Pain Management Strategies

The appropriate treatment for ear pain depends on its underlying cause. However, there are several general strategies that can help manage discomfort while addressing the root issue.

Over-the-Counter Pain Relief

For mild to moderate ear pain, over-the-counter pain relievers such as acetaminophen (Tylenol) or ibuprofen (Advil) can provide temporary relief. These medications can help reduce pain and inflammation associated with various ear conditions.

Warm or Cool Compresses

Applying a warm or cool compress to the affected ear can help alleviate pain and reduce inflammation. Some people find alternating between warm and cool provides the most relief.

Antibiotics for Bacterial Infections

If a bacterial infection is the cause of ear pain, a doctor may prescribe antibiotics. It’s important to complete the full course of antibiotics as prescribed, even if symptoms improve before finishing the medication.

Treating Underlying Conditions

For conditions like TMD, treatment may involve a multidisciplinary approach:

• Pain management medication
• Dental interventions for teeth grinding or misalignment
• Stress management techniques
• Physical therapy exercises

Professional Removal of Foreign Objects

If a foreign object is causing ear pain, it’s crucial to have it removed by a healthcare professional. They have the necessary tools and expertise to safely extract objects without damaging the delicate structures of the ear.

How long does it typically take for ear pain to subside? The duration can vary greatly depending on the cause. Some conditions may resolve within a few days, while others might require ongoing management. If pain persists or worsens despite treatment, it’s important to follow up with a healthcare provider.

Prevention Strategies for Ear Health

While not all causes of ear pain are preventable, there are several steps you can take to reduce your risk of ear-related issues:

• Practice good hygiene to prevent infections
• Avoid inserting objects into your ears, including Q-tips
• Protect your ears from loud noises
• Stay hydrated and chew gum during air travel to help equalize ear pressure
• Manage allergies and sinus conditions promptly
• Use earplugs or swim caps when swimming to prevent water from entering the ears

Is it true that using Q-tips can cause ear problems? Yes, contrary to popular belief, using Q-tips to clean your ears can actually push wax deeper into the ear canal, potentially leading to impaction or injury. It’s best to let your ears clean themselves naturally and only clean the outer part with a soft cloth.

By understanding the various causes of ear pain and implementing preventive measures, you can maintain better ear health and reduce the likelihood of experiencing sharp or persistent ear discomfort. Remember, if you’re ever unsure about the cause or severity of your ear pain, it’s always best to consult with a healthcare professional for proper diagnosis and treatment.

Sharp pain in the ear: Causes, symptoms, and treatments

Causes of sharp pain in the ear include pressure changes and infections. Often, they are not harmful, but some may need medical treatment.

The medical name for ear pain is “otalgia.” If the pain comes from within the ear, doctors call it primary otalgia. If it originates outside the ear, the term is secondary otalgia.

Below, we describe the many possible causes and their accompanying symptoms. We also outline ways to treat and prevent ear pain.

Share on PinterestSharp ear pain often results from pressure changes or infections.

Below are some causes of a sharp pain in the ear. The pain may result from one or a combination of these factors.

Each ear contains a narrow tube called a eustachian tube. It helps regulate the pressure inside the ear so that it matches the air pressure outside, enabling the eardrum to function properly.

Sometimes there is an imbalance in pressure, which may result from a blocked eustachian tube or a change in air pressure or altitude.

External pressure changes can cause a type of temporary ear damage called ear barotrauma. The symptoms can include:

• a feeling of pressure within the ear
• a sharp or dull pain in the ear
• hearing loss
• dizziness

Sinus infections

A sharp pain in the ear can sometimes result from an infection in the sinuses — a network of air-filled cavities in the skull.

There are three major types of sinus infection. They are:

• otitis, infection and inflammation of the ear, and the most common type of sinus infection
• mastoiditis, infection of the mastoid bone behind the ear
• sinusitis, inflammation of one or more paranasal sinuses, which are responsible for producing nasal mucus.

Sinus infections may be viral or bacterial.

Otitis

This, an infection in the inner or the outer ear, is one of the most common causes of ear pain.

An infection of the inner ear affects the eustachian tube, which connects the middle ear to the back of the nasal cavity and the upper throat. This usually has a viral cause and is most common among children.

An infection of the outer ear affects the ear canal, the tube that connects the outer ear and eardrum. The infection usually involves direct irritation of the ear canal, such as from water or objects such as Q-tips. It is most common in adults.

Besides sharp pain, some possible symptoms of an ear infection include:

• difficulty hearing
• a feeling of pressure or fullness in the ear
• discharge from the ear
• itchiness or irritation in and around the ear
• a fever
• low energy

Temporomandibular disorder

Temporomandibular disorder (TMD) is a musculoskeletal condition that primarily affects the joints that connect the jawbone to the skull.

People with TMD may experience sharp or dull jaw pain that radiates to the ears and temples.

Other possible symptoms of TMD include:

• clicking, popping, or grinding noises when moving the jaw
• difficulty opening the mouth fully
• the jaw locking when when opening the mouth

TMD is not usually serious and tends to get better on its own.

A foreign object in the ear

A foreign object may become stuck in the ear canal. Children, for example, prone to inserting objects into their ears out of curiosity.

A foreign object lodged in the ear can cause:

• sharp or dull pain
• drainage from the ear
• hearing loss
• an infection

A person attempting to remove the object at home could inadvertently push it farther into the ear canal. Instead, see a healthcare provider, who uses specially developed tools and procedures to remove these objects.

Depending on the cause of the ear pain, a person may also experience:

• a loss of hearing
• tinnitus, which involves perceiving noises that come from inside the ear
• a loss of balance
• vertigo
• facial nerve paralysis

A person may only experience sharp ear pain in certain situations, such as when yawning or swallowing. These motions open the eustachian tubes, changing the pressure within the ear.

Over-the-counter pain relief medication, such as acetaminophen (Tylenol) and ibuprofen (Advil) may help in the short term.

Otherwise, the best course of action depends on the cause and severity of the pain.

Recovery from an ear infection is usually spontaneous, so treatment is not always necessary. However, a doctor may prescribe antibiotics if the infection is bacterial.

A doctor will work to establish the cause of TMD, and they may then recommend one or more of the following:

• a prescription for stronger pain medication
• a referral to a dentist, if an issue such as teeth grinding or an incorrect bite is responsible
• a referral to a psychologist, if stress and anxiety are contributing

Over-the-counter pain relief medication can help ease minor to moderate ear pain and discomfort.

Also, holding a warm or cool compress against their ear may help alleviate the pain.

Some people use Q-tips to try to remove earwax, but this can actually push the wax back into the ear canal, causing problems. Anyone concerned about earwax buildups should see a doctor.

Ear infections are often responsible for a sharp pain in the ears, and these infections can be tricky to prevent. However, it can help to:

• not probe the ears with Q-tips or fingers
• prevent water and shampoo from entering the ears when showering or bathing
• use earplugs or a swimming cap when swimming
• treat eczema and other skin conditions
• treat any allergies to materials in hearing aids, if a person wears them
• avoid smoking and smoky environments

To prevent ear pain caused by changes in external pressure or altitude, try:

• yawning
• swallowing
• chewing gum
• sucking on hard candy
• blowing gently through pinched nostrils and swallowing

These can help open up the eustachian tubes, equalizing the pressure inside and outside the ear.

Sharp ear pain may resolve on its own. But if the pain is severe or the ear is bleeding, the person needs immediate medical care.

If someone experiences any of the following, they should consult a doctor:

• an earache that persists for more than 3 days
• recurrent ear infections
• swelling around the ear
• fluid draining from the ear
• hearing loss or another change in hearing
• a severe sore throat
• vomiting
• dizziness
• a fever or chills

Also, if sharp ear pain occurs in someone with any of the following health issues, they should see a doctor:

• diabetes
• a neurological disease
• heart disease
• lung disease
• kidney disease
• a weakened immune system

Sharp ear pain commonly results from an infection or a temporary change in air pressure or altitude. In other cases, it may stem from TMD or a foreign object lodged in the ear.

The pain, though unpleasant, may be no cause for concern and resolve without treatment.

However, if the pain is severe or persistent, or if it accompanies any other symptoms, such as bleeding or discharge, see a doctor. Sharp pain in the ear can stem from health issues that require prompt medical attention.

Symptoms, Causes, Treatments, and Prevention

Earaches usually occur in children, but they can also occur in adults. Injury, infection, irritation in the ear, or referred pain may cause earaches.

An earache may affect one or both of your ears. But most of the time, it’s in one ear. It may be constant or come and go, and the pain may be dull, sharp, or burning.

If you have an ear infection, you may also get a fever, and temporary hearing loss may occur. Young children who have ear infections tend to be fussy and irritable. They may also tug or rub their ears.

Read on for other symptoms, causes, treatments, and more.

Earaches can develop from ear infections or injury. Symptoms in adults include:

• ear pain
• impaired hearing
• fluid drainage from ear

Children can typically show additional symptoms, such as:

• ear pain
• muffled hearing or difficulty responding to sounds
• fever
• sense of fullness in the ear
• difficulty sleeping
• tugging or pulling at the ear
• crying or acting irritable more than usual
• headache
• loss of appetite
• loss of balance

Ear pain is felt somewhere other than the infection or injured site. For example, pain in the jaw or teeth may be felt in the ear.

Causes of earaches can include:

Ear infections

Ear infections are a common cause of earaches or ear pain. Ear infections can occur in the outer, middle, and inner ear.

Outer ear infection can be caused by swimming, wearing hearing aids or headphones that damage the skin inside the ear canal, or putting cotton swabs or fingers in the ear canal.

Skin in the ear canal that gets scratched or irritated can lead to infection. Water softens the skin in the ear canal, which can create a breeding ground for bacteria.

Middle ear infection can be caused by infections that stem from a respiratory tract infection. Fluid buildup behind the ear drums caused by these infections can breed bacteria.

Labyrinthitis is an inner ear disorder that’s sometimes caused by viral or bacterial infections from respiratory illnesses.

Other common causes of earaches

• change in pressure, such as when flying on a plane
• earwax buildup
• a foreign object in the ear
• strep throat
• sinus infection
• shampoo or water trapped in the ear
• use of cotton swabs in the ear

Less common causes of earaches

• temporomandibular joint (TMJ) syndrome
• perforated eardrum
• arthritis affecting the jaw
• infected tooth
• impacted tooth
• eczema in the ear canal
• trigeminal neuralgia (chronic facial nerve pain)

You can take several steps at home to reduce earache pain. Try these options to ease the ear pain:

• Apply a cold washcloth to the ear.
• Avoid getting the ear wet.
• Sit upright to help relieve ear pressure.
• Use over-the-counter (OTC) ear drops.
• Take OTC pain relievers.
• Chew gum to help relieve pressure.
• Feed an infant to help them relieve their pressure.

If you have an ear infection, your doctor will prescribe oral antibiotics or eardrops. In some cases, they’ll prescribe both.

Don’t stop taking the medication once your symptoms improve. It’s important that you finish your entire prescription to ensure that the infection will clear up completely.

If a buildup of wax is causing your ear pain, you may be given wax-softening eardrops. They may cause the wax to fall out on its own. Your doctor may also flush out the wax using a process called ear lavage, or they may use a suction device to remove the wax.

Your doctor will treat TMJ, sinus infections, and other causes of earaches directly to improve your ear pain.

If you or your child has a persistent fever of 104ºF (40 ºC) or higher, seek medical attention. For an infant, seek medical help immediately for a fever higher than 101ºF (38ºC). The Healthline FindCare tool can provide options in your area if you don’t already have a doctor.

You should also seek immediate medical attention if you have severe pain that stops suddenly. This could be a sign of the eardrum rupturing.

You should also watch for other symptoms. If any of the following symptoms appear, make an appointment with your doctor:

• severe ear pain
• dizziness
• bad headache
• swelling around the ear
• drooping of the facial muscles
• blood or pus draining from the ear

You should also make an appointment with your doctor if an earache gets worse or doesn’t improve in 24 to 48 hours.

You can book an appointment with a primary care doctor in your area using our Healthline FindCare tool.

Some earaches may be preventable. Try these preventive measures:

• Avoid smoking and exposure to secondhand smoke.
• Keep foreign objects out of the ear.
• Dry the ears after swimming or bathing.

Avoid allergy triggers, such as dust and pollen.

Read this article in Spanish.

Why does my ear hurt? — articles of the clinic “In Good Hands”

Ear pain is a symptom that can be caused by an inflammatory process or be reflex in nature. Often the pain spreads to neighboring organs: head, jaw.

Causes of ear pain:

There are also environmental factors:

• being outdoors during strong winds;

• water in the ear

• excess sulfur in the ears, or, conversely, its lack;

• physical trauma to the ear;

• a sharp drop in both arterial and atmospheric pressure;

Among other things, the ear can hurt for a number of reasons:

Only an otolaryngologist can determine the real root cause of painful sensations, who should be visited immediately when the first signs appear.

Ear pain, may be accompanied by a number of symptoms:

• General weakness, fatigue, decreased concentration and attention;

• Dizziness;

• Noise and ringing in the ears;

• Hearing loss;

• Sleep disturbance;

• discharge from the ears;

• Temperature increase;

• Nausea, vomiting;

Diagnostics

In addition to taking an anamnesis and visual examination of the ear, an otolaryngologist may prescribe additional studies:

• General blood analysis;

• Audiometry;

• Otoscopy;

• Acoustic impedancemetry;

• Ear manometry;

• X-ray of the temporal bone;

• CT and MRI;

• Electronystagmography;

• X-ray of the skull;

• Measurement with a tuning fork;

• Bacteriological culture of discharge from the ear;

• Otoacoustic emission;

We have the following specialists in our clinic:

• Chomaeva Marina Borodinovna

• Shakula Alexey Vladimirovich

• Gasparyan Shushanik Mamikonovna

Appointment is made by phone: +7 (861) 221-03-33

Ambulance: +7 (861) 272-03-03

Otalgia in the practice of an otorhinolaryngologist | Svistushkin V.

M., Morozova S.V.

Acute pain is important for the human body, performing a signal function in case of illness or traumatic injury, while pain is a painful or unpleasant sensation, physical and emotional suffering. With a sharp intensity and duration of pain, overstrain occurs, followed by depletion of neuropsychic functions [3].

Ear pain is one of the leading symptoms of acute inflammation or mechanical damage to the outer and middle ear, acoustic and barometric trauma. Otalgia (Greek ot [os] ear + algos pain) – pain in the ear area, an extremely painful condition for the patient. It can be caused either by diseases of the cranial nerves (trigeminal, vagus, glossopharyngeal), which provide innervation of this area, or be radiating in the presence of primary – extra-aural lesions (pathology of the bite and temporomandibular joints, carious teeth, pulpitis, periodontitis, periodontal disease, infectious-inflammatory and oncological diseases of the pharynx and oral cavity, etc. ) [1].

Depending on the cause, it is customary to distinguish 2 main forms of otalgia: neurotic and irradiative. The most common cause of irradiation otalgia is odontogenic pathology, but otorhinolaryngological diseases (tonsillitis, acute adenoiditis, epiglottitis, paratonsillar abscess, etc.) may be accompanied by radiating pain in the ear area.

One of the most common causes of irradiation otalgia is trigeminal neuralgia. With trigeminal neuralgia, a sensitivity disorder occurs, manifested by paroxysmal pain sensations in the zone of innervation. The causes of neuralgia are varied – they can be infectious and inflammatory diseases, exposure to neurotropic viruses, narrowing of bone canals and holes through which the branches of the trigeminal nerve pass, malocclusion, diseases of the dental system, atherosclerotic changes in blood vessels, multiple sclerosis. It is more common in women, has a predominantly right-sided localization. The factors predisposing to the occurrence of trigeminal neuralgia include angiogenic, vegetative, endocrine, metabolic, allergic, neuropsychiatric disorders. The etiological factors of trigeminal neuralgia also include arachnoiditis, malaria, tuberculosis, syphilis. Hypothermia, acute respiratory viral infections, influenza can provoke an exacerbation. The objective signs of trigeminal neuralgia include soreness of the Valle points: foramen supraorbitale (at the upper edge of the orbit), foramen infraorbitale (under the orbit) and foramen mentale (in the region of the root of the second lower premolar). However, the soreness of these points is not always observed and usually only during attacks. The presence of severe pain outside of attacks speaks more in favor of neuritis than neuralgia [5].

With neuralgia of the I branch of the trigeminal nerve, the pain point is projected in the foraminis supraorbitalis (n. supraorbitalis from n. ophthalmicus), pain occurs in the area of ​​the superciliary arch, forehead, in the temple, in the depths of the orbit. With neuralgia of the II branch, the pain point is determined in the foramen infraorbitale, the pain is localized in the upper teeth, palate, in the area of ​​the nasolabial fold, wing of the nose, upper lip. With neuralgia of the III branch, the main pain point is determined in the foramen mentale. Pain is felt in the lower lip, chin, tongue, cheek, teeth of the lower jaw.

The clinical picture of trigeminal neuralgia has bright, characteristic manifestations: pain, as a rule, is intense, paroxysmal, has a sharp, burning, cutting, boring character. Duration of painful paroxysm – from a few seconds to 2 minutes. The pain suddenly appears and just as suddenly disappears. The frequency of attacks is different: in some cases, pain attacks are rare, the pain is not sharp, the disease progresses slowly. In other cases, the frequency of attacks and the intensity of pain increase rapidly. Sometimes attacks can follow each other with such frequency that patients have the impression of their continuity. With frequently recurring attacks, pain is likely to spread to areas innervated by other branches of the nerve.

A pain attack occurs predominantly spontaneously, probably at the time of contraction of the mimic and chewing muscles – with laughter, chewing, talking, irritation of the skin of the face, cooling, emotional stress. Often there is a seasonal exacerbation of the disease – in the autumn-winter period.

The appearance of pain may be preceded by a sensation of itching. Sharp pain is usually limited to a small area, but it can spread over a considerable extent, the pain is localized either superficially or deeply. The suffering of such patients becomes so severe that they are ready for any surgical intervention, just to get rid of the pain [5].

With trigeminal neuralgia during the period of exacerbation, “trigger” – trigger zones are detected, which are areas the size of a small coin, touching which provokes an attack.

Trigeminal neuralgia is characterized by both sensitivity disorders and pronounced autonomic symptoms: local hyperemia or pallor of the skin of the face, reddening of the conjunctiva, hypersalivation, lacrimation, rhinorrhea. Attacks of pain are often accompanied by reflex contractions of the facial and chewing muscles. There are intense facial pains, pains in the area of ​​the eyeballs, vegetative-trophic disorders in the face area – swelling, greasiness of the skin, loss of eyebrows and eyelashes, eczema, atrophy of the skin and subcutaneous tissue. There are tonic and clonic hyperkinesis of the facial muscles. With neuralgia of the first pair of branches of the trigeminal nerve, blepharospasm is observed, with neuralgia of the II and III branches – hyperkinesis of the muscles of the lower half of the face, most often – trismus of masticatory muscles. If a weak touch easily provokes an attack, then intense irritation, on the contrary, stops it, therefore, patients usually vigorously rub the painful areas of the face during an attack [7].

For conservative treatment of patients with trigeminal neuralgia, anticonvulsants (carbamazepine, clonazepam, gabantin, gabapentin), muscle relaxants (baclofen, tizanidine, tolperisone), hormonal drugs, antidepressants, externally – topical drugs (ibuprofen + menthol, ketoprofen) are currently used. . As a rule, the use of narcotic analgesics brings relief.

In the complex treatment of patients with trigeminal neuralgia, B vitamins are widely used, primarily B1, B6 and B12. Their use is justified by the ability to improve the conduction of the nerve impulse and promote the restoration of the damaged structure of the nerve cell [4]. At present, both in Russia and abroad, enough information has been accumulated about the positive properties of the combined neurotropic drug Milgamma (Wörwag Pharma). Milgamma is not just a complex of vitamins, but a combination of neurotropic substances in therapeutic doses. Thus, Milgamma is not intended to compensate for the deficiency of vitamins, but to ensure the normal functioning of the nervous system. The injectable form of Milgamma contains a rational combination of therapeutic doses of B vitamins (B12 1000 μg, B1 100 mg, B6 100 mg). Each ampoule of Milgamma contains 20 mg of lidocaine, which makes intramuscular injections virtually painless for the patient. Cyanocobalamin (vitamin B12) affects the synthesis of myelin, thereby improving the conduction of nerve impulses. Thiamine (vitamin B1) has a significant effect on the processes of regeneration of damaged nerve fibers, is involved in the provision of energy processes in nerve cells and the normal function of the axoplasmic current. Pyridoxine (vitamin B6) supports the synthesis of transport proteins in the axial cylinders. In acute conditions, it is necessary to quickly achieve the optimal concentration of vitamins in the blood plasma, so it is advisable to start therapy with a parenteral route of administration – 10 daily intramuscular injections of Milgamma, followed by a transition to oral administration of Milgamma compositum for 20 days. In chronic pathology, the use of the drug Milgamma compositum is recommended, 1 tablet 3 rubles / day for 4 weeks. repeated courses 2-3 rubles / year.

Non-drug therapeutic measures increase the effectiveness of pharmacotherapy: acupuncture, vibration massage. In mild cases, darsonvalization, electrophoresis with novocaine, transcutaneous electrical stimulation of the affected branch are effective. Treatment is carried out by repeated courses, often in a hospital. Surgical treatment is based on the principle of sufficient resection of the nerve, separation of its peripheral and central sections.

Treatment of trigeminal neuralgia involves the need to cure or achieve stable remission of the primary disease. Considering that in almost all cases of typical neuralgia there are malocclusion and resulting changes in the temporomandibular joint, orthopedic treatment plays an important role in the treatment of neuralgia [1].

Otalgia may be due to Jacobson’s nerve neuralgia (Reichert’s syndrome, or tympanic plexus syndrome). Jacobson’s nerve departs from the stony node and goes to the tympanic cavity, where it splits into branches, which partly as part of the small superficial stony nerve, partly together with branches from the sympathetic plexus of the internal carotid artery form the tympanic plexus, which innervates the mucous membrane of the tympanic cavity, mastoid process and Eustachian tube.

Neuralgia of the Jacobson’s nerve is characterized by spontaneous attacks of cutting pain in the external auditory canal and the area adjacent to it. In contrast to neuralgia of the glossopharyngeal nerve, pain in Reichert’s syndrome is not associated with movements of the tongue and pharynx, and is not provoked by external stimuli. Pain in Reichert’s syndrome should be distinguished from pain in neuralgia of the geniculate node – Hunt’s syndrome (Zoster oticus), the clinical picture of which consists of ear pain, headache, sensorineural hearing loss, dizziness, lacrimation disorder and salivation, the presence of herpetic eruptions. Often in the first 10 days after the appearance of rashes, the facial nerve is affected with paresis of the facial muscles. Treatment is similar to that for trigeminal neuralgia [2].

Neuralgia of the pterygopalatine ganglion (ganglioneuritis of the pterygopalatine ganglion, Slader’s syndrome) is manifested by bouts of intense unilateral facial pain, accompanied by pronounced vegetative manifestations.

The pterygopalatine ganglion has the most complex structure of all the vegetative nodes of the face. There are 3 main roots in it, which provide extensive connections with various parts of the face and head. The sensory root is formed by several pterygopalatine nerves arising from the maxillary nerve, the parasympathetic root is a continuation of the large superficial stony nerve, a branch of the facial nerve. The sympathetic root is formed from the periarterial plexus of the internal carotid artery and is called the “deep petrosal nerve”. The last 2 pass together through the pterygoid canal called “nerve of the pterygoid canal, or Vidian nerve.” The pterygopalatine ganglion also has connections with the ciliary, ear, upper cervical sympathetic nodes and many cranial nerves (trigeminal, facial, glossopharyngeal). Through the pterygo-palatine opening and the pterygo-palatine canal, vegetative and sensitive innervation of the nasal mucosa, hard and soft palate, pulp of the upper teeth, upper pharynx, maxillary and main sinus, and ethmoid labyrinth are provided. The lacrimal gland is innervated through the inferior orbital fissure. Extensive connections of the pterygopalatine node determine the variety of clinical manifestations, wide irradiation of the pain syndrome.

Neuralgia of the pterygopalatine node is classified as a polyetiological disease. The leading role in the development of this neuralgia is assigned to inflammatory processes in the main and ethmoid sinuses located in close proximity to the pterygopalatine node, other sinusitis, odontogenic infection. Often the cause of the disease can be chronic tonsillitis and general infections, such as acute respiratory viral infections, influenza, etc. Allergic, mechanical, psychogenic, constitutional and other factors matter. A significant role in the occurrence of the disease belongs to the deformity of the nasal septum. Pterygopalatine ganglion syndrome is associated with vascular insufficiency in patients with hypertension and cerebral atherosclerosis. It should be noted that quite often the etiological factor still remains unidentified [5].

The classification of the syndrome of the pterygopalatine node according to the pathological principle distinguishes the lesion of the ganglion itself and the reflex irritation of the node. According to the clinical picture, expanded, partial and combined forms are distinguished. It is advisable to distinguish between ganglioneuralgic and ganglioneurotic forms, which is confirmed by the data of electrophysiological studies and the features of clinical manifestations. The ganglioneuralgic form is characterized by paroxysms of pain with severe vegetative-vascular and secretory disorders. In the ganglioneurotic form, patients complain of long-term persistent pain, against the background of which extended pain attacks can periodically occur and symptoms are revealed that indicate a partial loss of the functions of the pterygopalatine node.

The defeat of the pterygopalatine ganglion is a relatively rare disease. The clinical picture of the lesion of the pterygopalatine ganglion consists of painful paroxysms, vegetative-vascular disorders and emotional disorders. Vegetative disorders are obligate for patients with lesions of the pterygopalatine node. During an attack, they appear especially brightly and are described by the term “vegetative storm. ” In patients on the side of the pain syndrome, conjunctival hyperemia, reddening of half of the face, increased lachrymation and salivation, swelling and redness of the nasal mucosa, rhinorrhea from one half of the nose develop, swelling of half of the face or individual areas, more often of the upper eyelid, zygomatic region. In patients with the ganglionevritic form of the disease, in addition to the indicated paroxysmal autonomic disorders, dryness and hypotrophy of the nasal mucosa, xerophthalmia, and sometimes xerostomia are detected. An objective examination usually determines pain points at the inner corner of the eye, the root of the nose, in the region of the mastoid process and the projection points of the large palatine opening, which is medial to the middle of the hole of the extreme upper molar, palpation of the projection of the temporal artery is painful. In the study of the mental status of patients, emotional disorders of varying severity, phobic reactions during attacks, anxiety-hypochondriacal and anxiety-depressive states are determined [2].

The vegetative-trophic disorders accompanying the attack usually persist after the relief of the pain paroxysm. Within 2–3 weeks. (and in the ganglioneurotic form – up to several months) persistent hypesthesia is observed in the region of the sky, gums of the upper jaw, sensations of “bursting”, “tingling” in the region of the eyeball, nasal cavity, hyperemia and swelling of the mucous membrane of the nose and upper jaw, xerophthalmia.

Attacks usually begin spontaneously, without external stimuli, but they can be provoked by factors such as overwork, lack of sleep, alcohol consumption, excitement. One of the important diagnostic signs of damage to the pterygopalatine ganglion is the cessation of an attack after lubrication of the posterior sections of the middle turbinate with 2% tetracaine solution or 5% cocaine solution [5].

Thus, the basic principles of providing medical care to patients suffering from otalgia are competent timely diagnosis, a comprehensive individual approach to treatment, elimination of the disease, against which the pain syndrome developed.