to the ear. Conditions causing irritation the trigeminal nerve (cranial nerve V): Temporomandibular joint syndrome: inflammation or abnormal movements of the joint between the jaw and skull. These disorders are most common in women of childbearing age, and are uncommon in children younger than 10 years old. Myofascial pain syndrome: pain in the muscles involved in chewing. There may be certain parts of the muscles or tendons (connective tissue connecting the muscles to bones) that are especially painful when pressed Trigeminal neuralgia: attacks of shooting pain down the face that may be triggered by touching the face or temperature changes Dental pain from cavities or an abscess Oral cavity carcinoma Conditions causing irritation of the facial nerve (cranial nerve VII) or glossopharyngeal nerve (cranial nerve IX): Tonsillitis: infection/inflammation of the tonsils Post-tonsillectomy: pain following surgical removal of the tonsils Pharyngitis: infection/inflammation of the throat Sinusitis Parotitis: inflammation of the parotid gland, the salivary gland right in front of the ear Carcinoma of the oropharynx (base of tongue, soft palate, pharyngeal wall, tonsils) Conditions causing irritation of the vagus nerve (cranial nerve X): GERD Myocardial ischemia (inadequate oxygen supply to the heart muscle) Conditions causing irritation of cervical nerves C2-C3: Cervical spine trauma, arthritis (joint inflammation), or tumor Temporal arteritis: an autoimmune disorder leading to inflammation of the temporal artery, a large artery in the head. This condition tends to occur in adults older than 50. Pathophysiology Primary ear pain The ear can be anatomically divided into the external ear, the external auditory canal, the middle ear, and the inner ear. These three are indistinguishable in terms of the pain experienced. Secondary ear pain Many different nerves provide sensation to the various parts of the ear, including cranial nerves V (trigeminal), VII (facial), IX (glossopharyngeal), and X (vagus), and the great auricular nerve (cervical nerves C2-C3). These nerves also supply other parts of the body, from the mouth to the chest and abdomen. Irritation of these nerves in another part of the body has the potential to produce pain in the ear. This is called referred pain. Irritation of the trigeminal nerve (cranial nerve V) is the most common cause of referred ear pain. Diagnostic While some disorders may require specific imaging or testing, most etiologies of ear pain are diagnosed clinically. Because the differential for ear pain is so broad, there is no consensus on the best diagnostic framework to