AN unusual case of otalgia with severe, piercing, almost constant, shock-like pain localized deep in the ear of a girl of 12 years is described. Clinical examination and investigations failed to demonstrate any organic pathology in the ear, nose, para-nasal sinuses, fauces, pharynx, larynx, teeth, jaws, temporomandibular joint, salivary glands, neck or posterior cranial fossa. Medical treatment and infiltration of local analgesics around the cutaneous nerves brought no relief. The pain was relieved temporarily by chorda tympani neurectomy and permanently by section of the nervus intermedius, thus leading to a diagnosis of nervus intermedius neuralgia.

Pain is a warning signal against potential or actual damage to tissue cells. The middle ear is one of those areas which is sensitive to pricking, scratching, cutting, pressure or extremes of heat and cold.

Earache is a very common complaint. Pain may be felt in the ear but the cause may lie elsewhere. Such patients with referred otalgia often present to the otologist; rarely, they present with otalgia of neuralgic quality, with piercing, shock-like pain, without any demonstrable or detectable cause in the distribution of the cranial nerves supplying the ear. One such condition is the otological type of geniculate neuralgia, in which the pain is centered within the ear and may radiate to the deeper structures of the face; the attack may be paroxysmal or continuous.

The following case of otalgia is reported because of its rarity, its juvenile age of onset, and the problem posed in treatment. The patient was relieved only by surgical treatment.