Tragal pain most likely indicates which diagnosis?

• A. Otitis media
• B. Otosclerosis
• C. Presbycusis
• D. Otitis externa

Answer: (D)

Tragal tenderness is a classic sign of inflammation of the external auditory canal, i.e., otitis externa. When the tragus or outer ear is palpated and movement causes sharp pain, it points to infection or inflammation confined to the canal. Otitis media presents with deep ear pain and a painful, red, bulging tympanic membrane on exam, but the external canal is usually not tender. Otosclerosis and presbycusis cause hearing loss without this type of ear canal pain or tenderness. So the presence of tragal pain most strongly suggests otitis externa.