# Ear pain (otalgia) - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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. ## Treatment metadata - Paracetamol — 500 mg — oral.solid - Ibuprofen — 400 mg — oral.solid ## Complete treatment card ```text EAR PAIN (OTALGIA) 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. Review status: REVIEWED against 3 sources listed above (2026-08) 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 Source StatPearls "Otalgia" - disease-level clinical article Status traced to the source above 1. PARACETAMOL [1st line] Adult 1 g three or four times daily, maximum 4 g in 24 hours Peds 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.) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) 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. Caution 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. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid 2. IBUPROFEN [add-on - not a substitute] Adult 200-400 mg PO Q6-8H PRN, max 1200 mg/day. - As needed, shortest effective course Peds For pain and fever: 20 mg/kg/day in divided doses. 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. Caution 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. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)