Objectives: The aim of the present study is to evaluate the aetiology of secondary (referred) otalgia.
Patients and methods: A case series study of 79 patients clinically diagnosed as secondary otalgia, collected from the Outpatient Department of ENT at Al-Jamhory Teaching Hospital, Mosul/IRAQ, and private clinics, for the period from Jan. 2010 to Sept. 2011.
Results: The average age of the patients was 33.3 years with a range of 4-80 years. The peak age incidence was in the fourth decade of life. The study included 34 male patients (43.1%) and 45 females (56.9%) with a ratio of 1:1.3. Temporomandibular joint dysfunction was found to be the main cause of secondary otalgia (37.9%). Pharyngitis (24%), dental pain (17.7%) and cervical spine pain (7.6%) came next in that order.
Conclusion: Temporomandibular joint dysfunction, pharyngitis, dental problems and cervical nerve root pain were the commonest causes of secondary otalgia. Moreover, upper aerodigestive tract malignancies should be considered in differential diagnosis.

Keywords: Secondary otalgia, referred otalgia, referred ear pain.