Section P Ear and throat pain

Nov 18, 2025
3 min read

Index

Introduction
Understanding Ear and Throat Pain
Comprehensive History-Taking
ENT Examination: Key Components
Appropriate Investigations
Differential Diagnosis: Exploring the Possibilities
Initial Management Strategies
Importance of Accurate Documentation
Clinical Reflections and Skills Gained
Conclusion

1. Introduction

Ear and throat pain are among the most frequent complaints presented across primary and urgent care settings. These symptoms span a wide clinical spectrum—from benign, self-limiting infections to more complex conditions requiring targeted intervention. At Kraken Medical, we recognise the importance of a structured and evidence-informed approach to assessment and management.This reflective piece explores best practices in evaluating and treating ear and throat pain, drawing on core clinical skills, professional judgement, and patient-centred care.

2. Understanding Ear and Throat Pain

Otolaryngological (ENT) discomfort often overlaps, as shared nerve pathways can cause pain in one area to be felt in another. Ear and throat pain may result from infection, inflammation, obstruction, or referred pain from dental or maxillofacial origins. A systematic clinical approach ensures these various possibilities are thoroughly explored.

3. Comprehensive History-Taking

History-taking remains the foundation of safe and effective care. Establishing rapport enables patients to describe their symptoms more clearly, supporting diagnostic accuracy.

Key areas of enquiry include:

Onset and duration of symptoms
Character of the pain (sharp, dull, throbbing, intermittent)
Associated symptoms: fever, dysphagia, odynophagia, voice changes, nasal congestion, or hearing loss
Previous ENT infections or interventions
Impact on daily functioning, such as reduced oral intake or sleep disturbance

A patient-focused and empathetic consultation helps build a complete clinical picture, guiding the next steps in assessment.

4. ENT Examination: Key Components

A structured ENT examination is essential for identifying the source of symptoms and ruling out complications.

Ear Examination

Inspection of the external ear for swelling, erythema, or discharge
Assessment of canal patency
Otoscopy to assess the tympanic membrane for:
- Infection (e.g., otitis media)
- Perforation
- Effusion
- Wax impaction

Throat Examination

Inspection of the oropharynx for redness, swelling, and ulceration
Assessment of the tonsils for enlargement, exudate, or asymmetry
Evaluation of the uvula position and soft palate movement
Palpation of cervical lymph nodes

A holistic ENT examination also includes consideration of the nasal passages, as sinus or nasal pathology can contribute to referred pain.

5. Appropriate Investigations

Investigations are guided by clinical findings rather than used routinely.

Common investigations include:

Throat swabs: to identify bacterial pathogens such as Group A Streptococcus
Audiometry: helpful when hearing loss is present
Imaging (e.g., CT scan): reserved for suspected complications, persistent symptoms, or suspected structural abnormalities

These tools support diagnostic clarity and guide targeted management.

6. Differential Diagnosis: Exploring the Possibilities

A well-considered differential diagnosis ensures no key condition is overlooked.

Potential causes include:

Otitis media or externa
Pharyngitis or tonsillitis (viral or bacterial)
Wax impaction
Foreign body obstruction
Temporomandibular joint dysfunction
Dental infections or referred pain
Sinusitis

Holding a broad differential supports thorough assessment and timely escalation when required.

7. Initial Management Strategies

Management is tailored to the most likely diagnosis, patient symptoms, and clinical severity.

Supportive and Symptomatic Care

Analgesics such as paracetamol or NSAIDs
Adequate hydration
Saltwater gargles or throat sprays for discomfort

Antibiotic Therapy

Initiated when bacterial infection is strongly suspected or confirmed, particularly in:

Severe tonsillitis
Otitis media with systemic symptoms
Positive throat swab for bacterial pathogens

Foreign Body Management

If a foreign object is suspected in the ear or throat, careful removal is undertaken using safe and approved techniques. Referral may be appropriate when risk of harm is present.

A patient-centred management plan helps ensure safe recovery and effective follow-up.

8. Importance of Accurate Documentation

Clear and comprehensive documentation is a cornerstone of high-quality care.

This includes:

Presenting symptoms and patient history
Examination findings
Investigations ordered and their rationale
Differential diagnosis
Treatment plan and safety-netting advice

Accurate records support continuity of care, medico-legal safety, and collaborative practice.

9. Clinical Reflections and Skills Gained

Managing ear and throat pain reinforces several key clinical competencies:

Effective communication to build rapport and elicit essential details
Structured examination skills using otoscopy and oropharyngeal assessment
Judgement in selecting appropriate investigations based on patient need
Critical thinking when developing differential diagnoses
Safe prescribing and clinical decision-making
Clear documentation to maintain high clinical standards

These skills enhance practitioner confidence and contribute to safer patient outcomes.

10. Conclusion

Ear and throat pain are common yet clinically varied presentations. A systematic approach—rooted in high-quality history-taking, focused examination, and thoughtful management—ensures safe, effective, and patient-centred care.