Is a sore throat a rare symptom? Of course not - it is this complaint that is one of the most common both in the "cold season" and in the hot season. It is more than familiar to general practitioners and otolaryngologists. But why does the pain appear at the same time in the throat and in the ear? Not all people know that the ears and throat are anatomically connected by means of the auditory tubes - these are peculiar channels that communicate the pharyngeal cavity and the middle ear cavity. With inflammation of the pharynx, infectious agents can spread beyond its anatomical boundaries along the mentioned structures. However, this is not the only reason that both the ear and the throat hurt on one side. How to treat and how to help in each case?
Rationale for therapy
It is known that treatment cannot be effective if carried out without understanding the cause. In order for drugs and procedures to alleviate the condition, you need to imagine why this or that remedy is used. Therefore, it is important to find out what pathology the patient has encountered before starting treatment. This will avoid complications; in addition, in many cases, timely started therapy means less drug load on the body, since it is easier to cope with the disease at the initial stage.
Under what pathologies can both the throat and the ear hurt? These include:
- Inflammation of the lining of the pharynx (pharyngitis).
- Inflammation of the tonsils (tonsillitis).
- Inflammation of the lymphoid tissue of the lateral pharyngeal wall (angina of the lateral ridges).
- Inflammation of the paratonsillar tissue (paratonsillitis).
- Inflammation of the tissue around the pharyngeal space (parapharyngitis).
- Glossopharyngeal neuralgia.
- Awl sublingual syndrome.
It is important to understand whether the patient has otitis media, or whether we are talking about the irradiation of pain into the ear when a pathological process occurs in the oropharynx.
Irradiation is a non-specific symptom that is associated with the presence of changes on the affected side. If the pain radiates to the ear, this cannot mean only one, specific pathological process. On the contrary, there are many reasons why such a phenomenon occurs - they are present in the list above.
Thus, the first thing to do when choosing a treatment is to determine whether the infectious process has spread into the tympanic cavity or the patient's complaints are due to the phenomenon of irradiation and have nothing to do with otitis media.
In the second case, the patient does not require additional local therapy (ear drops and other means), which allows you to narrow the range of drugs and thereby reduce the risk of side effects, focusing on the underlying pathology.
Therapy tactics
Among infectious and inflammatory diseases of the oropharynx and tonsils, not only isolated, but also combined lesions - tonsillopharyngitis, that is, simultaneous inflammation of the mucous membrane in several anatomical areas - are often found. It is important to understand that a sore throat is usually bilateral in nature, but soreness in the ear can also occur on one side - for example, if pharyngitis is complicated by otitis media of the right or left ear.
Pain on only one side both in the throat and in the ear is characteristic of such pathological processes as:
- paratonsillitis;
- parapharyngitis;
- glossopharyngeal neuralgia;
- stylohyoid syndrome.
One-sided ear and throat pain is not always indicative of an infection.
With paratonsillitis, pain is mainly irradiated, and with parapharyngitis, soreness in the ear and a decrease in hearing acuity occur as a result of damage to the pharyngeal part of the auditory tube. Glossopharyngeal neuralgia and stylohyoid syndrome are characterized by the return of pain to the ear on the affected side, while the painful sensations are combined with one-sided pain in the throat and tonsil.
The approach to treatment depends on the type of primary pathology. It is impossible to treat only the throat or only the ear if the process has affected both the oropharynx and the tympanic cavity. It is also important to determine whether etiotropic therapy is possible (for example, antibacterial for streptococcal pharyngitis complicated by otitis media) and whether the patient needs hospitalization. The need for inpatient treatment arises:
- In the presence of severe complications of the main
process. - With severe intoxication (very high body temperature, vomiting, severe headache).
- If the patient is a small child, a pregnant woman, an elderly person.
process.Paratonsillitis and parapharyngitis are subject to treatment in a specialized department. Treatment of other pathologies accompanied by unilateral ear pain with sore throat is carried out in a hospital or on an outpatient basis (at home), depending on the severity of the patient's condition.
Systemic therapy
What to do for a patient who has a sore throat and ear? Systemic therapy for pharyngitis, tonsillitis and otitis media usually involves the use of antibacterial drugs. They are needed for bacterial etiology of the disease (for example, streptococcal pharyngitis, tonsillitis) or microbial complications of the primary infectious process (both bacterial and viral).
System forms can also be assigned:
- anti-inflammatory (Erespal);
- mucolytics (acetylcysteine);
- antihistamines (cetirizine);
- immunomodulators (Polyoxidonium).
The choice and combination of drugs depends on the form of otitis media, the type of inflammatory process (serous, purulent), changes in the oropharynx.
If the patient first had a sore throat, and after a short time there was a pain in the ear, it is worth thinking about the development of otitis media - the doctor selects the appropriate antibiotics. Usually, drugs with a wide spectrum of action from the group of penicillins or cephalosporins (Amoxicillin, Zinacef) are used.
Antibiotic therapy for otitis media that occurs against the background of pharyngitis or tonsillitis lasts at least 7-10 days.
In this case, the patient's condition is monitored - if the agent is ineffective, it must be replaced. However, even a significant improvement in well-being cannot be a reason for an independent refusal from antibiotics before the time indicated by the doctor. This is associated with the risk of complications and contributes to the development of chronic inflammatory processes.
With paratonsillitis and parapharyngitis, systemic therapy may include all the drugs listed above, as well as detoxification methods (infusion of 0.9% sodium chloride solution and other drugs intravenously). But at the same time, in many cases, surgical intervention is also indicated for the purpose of opening and 
drainage of the abscess. Since irradiation into the ear does not indicate the development of otitis media, all therapeutic measures are aimed at stopping the main process. Pain relievers are not complete treatments and are only used symptomatically.
Patients who suffer from glossopharyngeal neuralgia and / or stylohyoid syndrome are prescribed:
- analgesics (Metamizole sodium);
- anticonvulsants (carbamazepine)
- B vitamins.
Surgical treatment of these pathologies is also widely used.
Local therapy
Local therapy is the use of drugs within the boundaries of the affected area: treatment of the mucous membrane of the oropharynx and tonsils by rinsing the throat (Furacilin, chamomile infusion, saline solution), spray irrigation (Ingalipt), resorption of tablets (Strepsils, Decatilen). The drugs may include pain relievers. Local action is necessary - if the activity of the inflammatory process in the throat decreases, the symptoms from the ear will quickly regress.
Local therapy is also required for otitis media. Since dysfunction of the auditory tube plays an important role in the development of tubo-otitis (eustachitis), the following actions are taken:
- Introduction of vasoconstrictor nasal drops (Xylometazoline, Phenylephrine).
- Introduction of combined nasal drops (Dexamethasone in combination with Mezaton and other components).
To free the nose from mucus with concomitant rhinitis (runny nose), you need to carefully, closing one nostril and removing the congestion from the other - without undue effort. If the decision is made to rinse the nose, the solution flow should not enter the nostrils under high pressure.
If the patient develops catarrhal or purulent otitis media, in addition to the systemic ones, local dosage forms of antibiotics (Tsipromed, Ofloxacin), drops with anti-inflammatory and analgesic effects (Otipax) are prescribed. With purulent otitis media after perforation of the tympanic membrane, a thorough toilet of the ear is necessary. Tympanopuncture (puncture of the tympanic membrane to drain accumulated exudate) may be required. It is performed by an otolaryngologist (ENT).
With purulent otitis media, thermal procedures are contraindicated.
In some types of otitis media, the use of heating (for example, dry heat) is permissible, but in case of purulent inflammation, it is enough to use this method once, so that the risk of complications from a relatively probable one becomes almost guaranteed. It is worth noting that the pain in purulent otitis media is reduced after perforation of the tympanic membrane (spontaneous or targeted), therefore, you should immediately consult a doctor.
Local treatment for glossopharyngeal neuralgia consists in lubricating the root area of the tongue with drugs belonging to the group of anesthetics (Dikain). For patients diagnosed with stylohyoid syndrome, local administration of anesthetics and anti-inflammatory drugs (hydrocortisone) to the styloid process is indicated. No local action is required in the area of the ear structures.
Although the causes of pain in both the throat and the ear on the one hand are varied, it is infectious and inflammatory processes that are most often found. Otitis media treatment should be started as early as possible.
In no case should you endure severe pain both in the throat and in the ear - this symptom may indicate the development of a purulent process, which sometimes requires urgent surgical intervention.
