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| | THE MERCK MANUAL, Sec. 7, Ch. 82, Approach To The Patient With Ear Problems |
 | | Earache (otalgia) occurs with infections and neoplasms in the external or middle ear (see Table 82-2) or is referred to the ear from remote disease processes (see Table 82-3). |
 | | If there is no disease in the ear, the source of referred pain should be sought in areas receiving sensory supply from the cranial nerves that subserve sensation in the external and middle ear--ie, the 5th (trigeminal), 9th (glossopharyngeal), and 10th (vagus) nerves. |
 | | Specifically, the cause of obscure otalgia should be sought in the nose, paranasal sinuses, nasopharynx, teeth, gingiva, temporomandibular joint, mandible, parotid glands, tongue, palatine tonsils, pharynx, larynx, trachea, and esophagus. |
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