Patients may complain of ear pain when suffering from nonotogenic conditions The sensory innervation of the auricle, external auditory canal, middle and inner ear involve cranial nerves V, VII, IX, and X These same cranial nerves, particularly VII, IX, and X, also provide sensory innervation of the mouth, throat, and sinuses Referred pain from pharyngitis, sinusitis, stomatitis, dental infections, and in rare cases, tumors of the head and neck may be experienced as ear pain The postauricular area is supplied by C2 and C3, and neck injuries, disc problems, arthritis may cause referred pain to that region When no otic cause is found in children presenting with ear pain, clinicians should carefully evaluate the surrounding structures to identify other causes of the discomfort The Children’s Hospital of Philadelphia Clinical Pathway Clinical Pathway for Evaluation/Treatment of Acute Otitis Media in Children Months to 12 Years Old URL: https://www.chop.edu/clinical-pathway/otitis-media-acute-clinicalpathway Author: M Joffe, MD Posted: November 2008, last revised January 2020 Suggested Readings and Key References Conover K Earache Emerg Med Clin North Am 2013;31:413–442 Ghanem T, Rasamny JK, Park SS Rethinking auricular trauma Laryngoscope 2005;115:1251–1255 Hoberman A, Paradise JL, Rockette HE, et al Treatment of acute otitis media in children under years of age N Engl J Med 2011;364:105–115 Kaur R, Morris M, Pichichero ME Epidemiology of acute otitis media in the postpneumococcal conjugate vaccine era Pediatrics 2017;140(3):e20170181 Lieberthal AS, Carroll AE, Chonmaitree T, et al Clinical practice guideline: the diagnosis and management of acute otitis media Pediatrics 2013;131(3):e964– e999 McCormick DP, Lim-Milia E, Saeed K, et al Otitis media: can clinical findings predict bacterial or viral etiology? Pediatr Infect Dis J 2000;19:256–258 Pichichero ME A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients Pediatrics 2005;115:1048–1057