Dawaa Reference

acute

Ear pain (otalgia)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · MSF Essential Drugs 2024 - paracetamol (oral) · Coulter J, Hohman MH, Kwon E. Otalgia. [Updated 2024 Feb 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK549830; PMID: 31751020.

Verified against3 documents
  • MSF Essential Drugs 2024 - paracetamol (oral)
  • SmPC section 4.2, https://www.medicines.org.uk/emc/product/4560/smpc
  • Coulter J, Hohman MH, Kwon E. Otalgia. [Updated 2024 Feb 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK549830; PMID: 31751020.

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (3)

  • Ear pain is either from the ear itself or referred from somewhere else, and both must be weighed [ear pain]
  • Chest pain plus cardiac risk factors means the heart needs assessing in full [chest pain]
  • Warning gut symptoms alongside the ear pain point to the oesophagus [ear pain]

Signs — what you find (10)

  • Blisters seen down the otoscope mean shingles of the ear; add facial weakness and it is Ramsay Hunt [blisters · facial weakness]
  • The nose may show swollen lining or polyps, and rhinoscopy may uncover long-standing sinus disease [polyp]
  • Look in the mouth for decayed teeth, loose fillings, mouth ulcers, lumps or abscesses [mouth ulcers]
  • Feeling inside the mouth can pick up a long styloid process or a calcified ligament, as in Eagle syndrome
  • Jaw joint exam may find tender temporalis, pterygoid or masseter muscles, trigger points, or joint dysfunction
  • Tenderness tracking along the superficial temporal artery suggests temporal arteritis
  • Examining the head may turn up parotid or other salivary gland disease, a gland tumour or infection
  • The neck may hold enlarged nodes or thyroid disease, pointing to thyroiditis or nodal spread of cancer [lymphadenopathy]
  • Examining the neck spine may show myofascial pain or wear in the cervical discs
  • Cranial nerve testing can expose Ramsay Hunt or neuralgia of the geniculate, trigeminal, glossopharyngeal, sphenopalatine, vagal or occipital nerves [neuralgia]

Tests (12)

  • Looking in the ear is usually enough to say whether the pain starts there or is referred
  • Acute middle ear infection is the commonest cause and shows on plain otoscopy; on pneumatic otoscopy the drum looks dull, bulges and will not move
  • For that infection nothing beyond history and examination is usually needed, unless a warning feature is present
  • For a blocked eustachian tube, tympanometry shows a stiff drum or negative pressure behind it; add audiometry if hearing has dropped
  • A normal-looking ear means hunting for a referred source, with the clinical picture deciding which blood tests or scans are worth doing
  • A panoramic dental x-ray shows the jaw and every tooth quickly; jaw joint disorder does not routinely need imaging
  • When examination cannot exclude something serious, move to CT or MRI of head and neck and endoscopy of the throat and voice box
  • CT of the temporal bone finds petrous apicitis; CT or MRI also assesses aggressive outer-ear infection, and MRI assesses the cranial nerves
  • Biopsy of the suspect site and of suspicious nodes is what excludes a head and neck cancer
  • When the ear looks normal, a full blood count screens for infection outside the ear or in the body generally
  • Suspected temporal arteritis needs ESR or CRP; an ESR greater than 50 mm per hour calls for urgent eye and ENT referral
  • Pain still present beyond 4 weeks calls for specialist referral and more advanced tests

If not this — what else fits (12)

  • Middle ear infection, whether recent or long-standing
  • Outer ear infection: acute otitis externa, blistering myringitis, or perichondritis of the pinna
  • Shingles of the ear and Ramsay Hunt, or aggressive spreading outer-ear infection
  • Mechanical causes: a blocked eustachian tube, impacted wax, or pressure injury from flying or diving
  • Injury: blood collected in the pinna, a broken temporal bone, a torn drum, or something stuck in the canal
  • A lump or ongoing inflammation of the ear: skin cancers, melanoma, cholesteatoma, chondrodermatitis nodularis helicis, relapsing polychondritis, granulomatosis with polyangiitis
  • Jaw, teeth and skull base: joint dysfunction, tooth grinding, decay, cancer of the tongue, Eagle syndrome, petrous apicitis
  • Salivary and thyroid disease: gland infection, a salivary stone or tumour, thyroiditis, thyroid cancer
  • Throat and voice box: sore throat, tonsillitis, pain after tonsillectomy, tonsil stones, deep neck abscess, throat or voice box cancer, laryngitis, vocal cord dysfunction
  • Neck and nerve sources: carotidynia, enlarged or cancerous nodes, and neuralgia of the geniculate, trigeminal, glossopharyngeal, sphenopalatine, vagal or occipital nerves
  • Blood vessel and sinus sources: temporal arteritis, sinus infection, nasal polyps
  • Further afield: myofascial pain, wry neck, worn neck discs or a trapped root, lung disease, heart attack, reflux or oesophageal cancer

SourceStatPearls "Otalgia" - disease-level clinical article

Presentation findings are traced to the source above.

1

PARACETAMOL

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

1 g three or four times daily, maximum 4 g in 24 hours

Paediatric dose

15 mg/kg/dose [child max 500 mg]

(Child 1 month and over: 15 mg/kg per dose, 3 or 4 times daily, maximum 60 mg/kg daily. Child under 1 month: 10 mg/kg per dose, 3 or 4 times daily, maximum 40 mg/kg daily. MSF's own weight table gives one 500 mg tablet three times daily from 30 kg to under 50 kg, so 500 mg is the per-dose ceiling; the 60 mg/kg daily total still applies.)

Dose by weight
3kg45 mg/dose
4kg60 mg/dose
5kg75 mg/dose
6kg90 mg/dose
7kg105 mg/dose
8kg120 mg/dose
9kg135 mg/dose
10kg150 mg/dose
11kg165 mg/dose
12kg180 mg/dose
13kg195 mg/dose
14kg210 mg/dose
15kg225 mg/dose
16kg240 mg/dose
17kg255 mg/dose
18kg270 mg/dose
19kg285 mg/dose
20kg300 mg/dose
21kg315 mg/dose
22kg330 mg/dose
23kg345 mg/dose
24kg360 mg/dose
25kg375 mg/dose
26kg390 mg/dose
27kg405 mg/dose
28kg420 mg/dose
29kg435 mg/dose
30kg450 mg/dose
31kg465 mg/dose
32kg480 mg/dose
33kg495 mg/dose
34kg500 mg/dose (capped)
35kg500 mg/dose (capped)
36kg500 mg/dose (capped)
37kg500 mg/dose (capped)
38kg500 mg/dose (capped)
39kg500 mg/dose (capped)
40kg500 mg/dose (capped)
41kg500 mg/dose (capped)
42kg500 mg/dose (capped)
43kg500 mg/dose (capped)
44kg500 mg/dose (capped)
45kg500 mg/dose (capped)
46kg500 mg/dose (capped)
47kg500 mg/dose (capped)
48kg500 mg/dose (capped)
49kg500 mg/dose (capped)
50kg500 mg/dose (capped)
Dose source

MSF Essential Drugs 2024 - paracetamol (oral)

Why

Symptomatic relief of the pain and fever only. It does not treat the cause, and the dose is the same whatever the cause is.

Cautions
  • Severe pain with facial weakness, mastoid swelling or tenderness, or systemic illness suggests mastoiditis or another complication needing urgent referral.
  • Relief only - it does not treat what is causing the pain or fever.
  • Check every other product the patient is taking for paracetamol; combination cold and flu preparations are the usual route to an accidental overdose.
  • Reduce the dose in significant liver disease, chronic alcohol use, or low body weight.
Egyptian brands
Egyptian brandManufacturerIndicative price
FEBRIMOL 500 MG 20 TAB.PHARCO3.50 EGP (0.17/unit)
CETAMOL 500 MG 20 TABS.MEMPHIS8.00 EGP (0.40/unit)
PARACETAMOL-MUP 500MG B.P. 20 TABS.MUP13.00 EGP (0.65/unit)
CETAL 500 MG 20 TABS.EIPICO24.00 EGP (1.20/unit)
ARKADOLOW 500 MG 30 F.C. TABS.UTOPIA42.00 EGP (1.40/unit)
PARAMOL 500MG 20 TAB.MISR38.00 EGP (1.90/unit)
ADOL 500MG 24 CAPLETSJULPHAR32.00 EGP
AUGICETAMIDE 500 MG 20 SACHETSAUG PHARMA50.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral solidPHARCO4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral solidPHAROPHARMA5.00 EGP
2

IBUPROFEN

add-on - not a substitute

Strength400 mg

Formoral.solid

Adult dose and duration

200-400 mg PO Q6-8H PRN, max 1200 mg/day. - As needed, shortest effective course

Paediatric dose

For pain and fever: 20 mg/kg/day in divided doses.

Dose source

SmPC section 4.2, https://www.medicines.org.uk/emc/product/4560/smpc

Why

An anti-inflammatory analgesic for the pain and any inflammatory component. Symptomatic only; the dose does not change with the underlying diagnosis.

Cautions
  • Relief only - it does not treat what is causing the pain.
  • Take with or after food, and give gastroprotection if it is needed for more than a short course or the patient is over 65.
  • Avoid in dehydration and in anyone not drinking - the kidney risk is highest there.
  • Avoid in active peptic ulcer, significant kidney disease, and heart failure. CONTRAINDICATED in the third (last) trimester of pregnancy. In the first and second trimesters, do not give unless clearly necessary, at the lowest dose for the shortest time.
  • Avoid in active peptic ulcer, significant kidney disease, heart failure; contraindicated during the third trimester of pregnancy.
Egyptian brands
Egyptian brandManufacturerIndicative price
DAJUANOFEN 400 MG 20 F.C. TABS.COPAD PHARMA5.00 EGP (0.25/unit)
FLABU 400MG 10 F.C.TAB.DELTA PHARMA3.75 EGP (0.38/unit)
NOVA-PROFEN 400MG 30 F.C. TABLETSSANOFI12.75 EGP (0.42/unit)
IBUPROFEN 400 MG 10 TAB.SEDICO6.00 EGP (0.60/unit)
MAFO 400 MG 30 F.C.TABSEIPICO42.00 EGP (1.40/unit)
BRUFEN 400 MG 30 TABS.KAHIRA > ABBOTT LABORATORIES78.00 EGP (2.60/unit)
PROFUSOL 400MG 20 S.G CAPS.EUROPEAN EGYPTIAN PHARM. IND.31.00 EGP
ANALGIPROF 400 MG 25 SACHETSEVA PHARMA37.50 EGP
NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solidSANOFI2.25 EGP
BRUFEMOL-N SUSP. 60 ML? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)4.50 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.