Referred Otalgia Induced by a Large Tonsillolith
A previously healthy 35-year-old woman presented with acute left ear pain lasting for 4 hours. The pain was dull, continuous, with moderate intensity and aggravated during chewing and swallowing. There were no other associated symptoms such as tinnitus, hearing loss, or vertigo. The medical and family histories including recurrent throat infections were insignificant.\nOn examination, the ear canal and the ear drum were intact () and there was no evidence of infection. However, she still had persistent pain in the left ear. Because a provisional diagnosis of referred otalgia was made, we performed a further assessment to identify the source of referred pain. On oral examination, a large tonsillolith was observed lodged in the upper pole of the left palatine tonsil (). On palpation the mass was hard and nontender. The rest of the nose and throat examination did not reveal any abnormalities. There was no cervical lymphadenopathy. A clinical diagnosis of referred otalgia due to a tonsillolith was made. The tonsillolith was easily and completely removed from the tonsil without any anesthesia (). It was yellowish white in color and measured 1.2 × 0.4 × 0.7 cm (). She reported prompt relief of her otalgia.