| Course | PA 516 Comprehensive Clinical Module HEENT (Head, Ears, Eyes, Nose, Throat) |
|---|---|
| Week | 6 |
| Paper type | Referred pain mapping |
| Length | About 830 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 516 Week 6
Referred Pain Mapping for Right Ear Pain Behind a Drum That Explains Fullness but Not Pain: Five Nerve Territories, a Firm Level II Node and the One Candidate the Map Cannot Leave
Student Name
Chamberlain University
PA 516: Comprehensive Clinical Module HEENT (Head, Ears, Eyes, Nose, Throat)
Instructor Name
Month Day, Year
Referred Pain Mapping for Right Ear Pain Behind a Drum That Explains Fullness but Not Pain: Five Nerve Territories, a Firm Level II Node and the One Candidate the Map Cannot Leave
Start Where It Hurts
Three weeks after the irrigation, T.M. returned with a new complaint: a deep, dull ache in the right ear for ten days, worse at night, "like it's behind the ear hole, not in it." T.M. pointed with one finger to the right tragus and the area just below the earlobe. No discharge, no fever, no itching. The fullness and muffled hearing continued.
Negatives Are the Starting Point
Right ear: canal clean and not tender; no pain when the tragus was pressed or the pinna pulled. Drum unchanged from the earlier visit, amber with a fluid line and reduced mobility, not red or bulging. Mastoid not tender. An uncomplicated effusion causes fullness, not a deep, persistent ache, and nothing seen in the ear explains a pain that wakes T.M. at night. That gap is the reason for this map: when ear pain is not explained by the ear, the pain is likely being referred from another structure that shares its nerve supply (Ramazani et al., 2023).
Follow the Nerve, Not the Ear
The ear receives sensory fibers from five sources, each of which also supplies structures far from it (Norris & Koontz, 2020).
Table 1
Shared Nerve Territories of the Ear and What Was Examined in Each
| Nerve | Shared territory | What was examined | Result |
|---|---|---|---|
| Trigeminal, mandibular branch | Jaw joint, lower molars, floor of mouth | Jaw opening, joint palpation, teeth tapped | Opening 42 mm, no click, no joint tenderness; molars not tender |
| Facial | Skin of the canal and concha | Facial movement, canal skin | Symmetric face; canal skin normal |
| Glossopharyngeal | Tonsils, back of the tongue, nasopharynx, eustachian tube | Oropharynx with light and tongue blade | Tonsils small and symmetric; nasopharynx not visible |
| Vagus | Larynx, pyriform sinus, esophagus | Voice, swallowing, neck palpation | Voice clear; no pain on swallowing |
| Second and third cervical nerves | Skin behind and below the ear, upper neck | Neck examination | Firm, nontender right level II node, about 1.5 cm, not mobile on the deep tissue |
Note. Note. Level II is the upper jugular group below the angle of the jaw. The nasopharynx cannot be seen with a tongue blade.
Each Candidate Argued
Jaw joint: the most common source of referred ear pain in adults, but the opening, sounds and palpation were normal, and the pain does not change with chewing. Unlikely.
Teeth: no tender molars, no recent dental work, no pain with hot or cold. Unlikely.
Tonsil and oropharynx: seen and normal. Unlikely as the source, though the view does not reach below the tongue base.
Larynx and hypopharynx: no voice change, no pain on swallowing, but these were not seen directly. Not excluded.
Nasopharynx: not seen, and it is the one structure that can explain everything at once. A mass at the opening of the right eustachian tube would block it, cause a one-sided effusion in an adult, refer pain to the ear through the glossopharyngeal nerve and drain to the upper neck nodes. Nasopharyngeal carcinoma often presents first with a neck mass and ear symptoms on one side (Chen et al., 2019).
The Node Changes the Weight
A firm node of 1.5 cm in the upper neck, fixed and without tenderness, in a 54-year-old with no recent infection, is a finding of its own. Together with the effusion and the ear pain, it moves the nasopharynx from a theoretical candidate to the leading one. T.M. is a former smoker of twenty pack-years who stopped eight years ago, which adds weight to a head and neck source.
What T.M. Was Told
T.M. was told that the ear itself did not explain the pain, that the pain may be coming from somewhere nearby that shares the same nerves, and that the lump in the neck needed to be explained too. T.M. was not told a diagnosis, because there is none yet. The word cancer was not used first, but when T.M. asked directly whether this could be a tumor, the answer was that it is one of the possibilities the specialist will look for and that the clinic wanted that look to happen soon. T.M. asked for written notes for the dispatch office and was given a summary of the next steps.
Stop Before the Plan
This document maps the pain; it does not order tests. The map leaves two structures unexamined, the nasopharynx and the larynx and hypopharynx below the tongue base, and both can only be seen with an endoscope. The next documents decide how to look.
References
Chen, Y.-P., Chan, A. T. C., Le, Q.-T., Blanchard, P., Sun, Y., & Ma, J. (2019). Nasopharyngeal carcinoma. The Lancet, 394(10192), 64-80. https://doi.org/10.1016/S0140-6736(19)30956-0
Norris, C., & Koontz, N. (2020). Secondary otalgia: Referred pain pathways and pathologies. American Journal of Neuroradiology, 41(12), 2188-2198. https://doi.org/10.3174/ajnr.A6808
Ramazani, F., Szalay-Anderson, C., Batista, A. V., Park, P., Hwang, E., Chau, J., & Lui, J. (2023). Referred otalgia: Common causes and evidence-based strategies for assessment and management. Canadian Family Physician, 69(11), 757-761. https://doi.org/10.46747/cfp.6911757
What the PA 516 Week 6 assignment asks for
In week six you map ear pain that the ear itself does not explain. Fix the site first, in the patient's words and with where they pointed. Then report the examination of the ear in full, including negatives, because a normal or unchanged ear is why the map exists. Lay out the nerves that supply the ear and the distant structures they share, in a drawing, table or list. For each territory, record what you examined and what you found. Argue each candidate source, saying which the exam made unlikely and which it simply could not reach. Note any extra finding, such as a neck mass, that changes the weighting. End with the structures still unexamined, and leave the plan for a separate document. Cite sources for the anatomy of referred pain.
Inside the PA 516 Week 6 example
T.M. returns with ten days of a deep night-time ache pointed to just in front of and below the right ear. Ear findings are recorded first: no tragal pain, the same amber drum and fluid line, no mastoid tenderness, which cannot explain the pain. Ramazani and colleagues are cited on referred ear pain. Table 1 lists five nerves with their shared territories, what was examined and the result, from a normal jaw opening of 42 mm to a firm, fixed level II node. Each candidate is argued in a line or two, with the jaw, teeth and tonsils made unlikely and the larynx and nasopharynx not reached. The node and a former smoking history raise the nasopharynx, citing Chen and colleagues. A section records what T.M. was told, and the paper stops at the unexamined structures.
Where the points sit in the PA 516 Week 6 rubric
The marks on this map go mainly to the logic of looking elsewhere. A paper that skips the ear exam, or treats the effusion as enough to explain the pain, loses the largest share because the map then has no reason to exist. Next in weight is anatomical accuracy: each nerve must be tied to the right shared territories. Faculty give strong credit when every candidate is argued against the exam instead of merely listed, and when the paper separates structures that were cleared from those simply out of reach. A neck finding left out or not weighed costs points. Deductions also follow for a plan or order slipped into the map, since the week grades reasoning, not management. Sources on referred pain pathways should be cited and listed in APA style.
PA 516 Week 6 help from the desk
A common shortfall in this assignment is a list of every cause of ear pain with no link to the exam. Send your case, the ear findings and anything else you examined, and the custom sample will fix the pain site, record the negative ear findings first and build a table of nerve territories with your findings in each. Every candidate is argued from your exam, and the sample says plainly which ones could not be reached. If your case has a neck mass, a dental finding or a jaw problem, it is weighed in its own section. The map ends without a plan unless your prompt asks for one. Make sure the anatomy and findings match your course text and notes before you use the model.
Get a PA-516 Week 6 example written to your instructions
Send the Week 6 case and instructions, including whether a drawing or a table is expected, and a custom PA-516 referred pain map is written to that format and returned inside 24 to 48 hours, the first free. Say which structures your section listed and the example works through those.
More PA 516 papers and MPAS samples
- PA 516 Week 1: Hidden Eardrum Discussion Post
- PA 516 Week 2: Tympanic Membrane Documentation
- PA 516 Week 3: Tuning Fork Interpretation
- PA 516 Week 4: Fundoscopic Exam Limits Write-Up
- PA 516 Week 5: Visual Acuity Documentation
- PA 516 Week 7: Sinus Imaging Rationale
- PA 516 Week 8: ENT Referral Letter
- PA 514 Week 6: Antibiogram Reading Exercise
- PA 512 Week 6: TNM Staging Worksheet
- PA 510 Week 6: Pigmented Lesion Evaluation
- PA 505 Week 6: Substance Use History Brief
PA 516 Week 6 questions, answered
Does the map have to be a drawing?
Only where the section says so, and many accept a table or short paragraphs instead. The graded content is the set of relationships, not the rendering. Where a drawing is required, finished examples keep the labels tied to the same candidates the prose argues, so the two halves of the document agree with each other rather than listing different structures.
How many candidate structures belong on it?
Enough to cover the territories supplying the painful site, which usually lands at four to six rather than an exhaustive anatomical run. Finished versions argue each one briefly instead of naming many and defending none. Where the classroom supplies its own list, the example works through exactly that list and adds nothing to it.
Can I use a real case from clinical?
Check what your section allows first, since several restrict this week to the vignette issued in the classroom. Where a real encounter is permitted, finished examples carry no identifying detail of any kind and the clinical record itself never travels into the assignment. Send the instructions either way and the example is built from whatever material your classroom sanctions.
Where can I find a free PA 516 Week 6 sample paper?
The full PA 516 Week 6 referred pain map is on this page, tracing a right ear ache through five nerve territories to the unexamined nasopharynx.
Why does the PA 516 Week 6 sample end on the nasopharynx?
It is the one structure that could explain the one-sided effusion, the ear pain and the firm upper neck node together, and it cannot be seen without an endoscope.