In this case the otalgia belongs to the fourth class of diseases. From Wordnik.com. [Zoonomia, Vol. II Or, the Laws of Organic Life] Reference
When patients in endemic areas present with fever and rash and have sensorineural hearing loss or otalgia without otoscopic abnormalities, clinicians should suspect scrub typhus and consider empirical antibiotic therapy. From Wordnik.com. [BioMed Central - Latest articles] Reference
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