Primary otalgia is caused by auricular and periauricular disease, while referred otalgia is caused by disease originating from remote structures. Referred otalgia is common because of the multiple cranial nerves and branches of the cervical plexus that supply sensory innervation to both the ear and other structures of the head and neck. The sensory innervation of the ear is mediated by the fifth, seventh, ninth, and tenth cranial nerves as well as the cervical plexus, with much overlapping and variability. Common causes of primary and referred otalgia are listed in Table.2.3.1-1,.

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