A Review of Medicinal Plants Used in Iranian Traditional Medicine to Alleviate Otalgia

Otalgia, or ear pain, is a prevalent condition with otogenic and referred etiologies, affecting nearly everyone at least once in their lifetime. Iranian Traditional medicine (ITM), also known as Persian medicine employs numerous medicinal plants, used individually or in combination, to alleviate ear pain. Given the prevalence of otalgia and the potential of medicinal plants, this review aimed to identify ITM-derived medicinal plants and their proposed mechanisms for relieving ear pain. ITM literature was searched for analgesic medicinal plants used for earache, using traditional terms for "pain" and related phrases, and they were ranked by their citation frequency and emphasized efficacy. The plants were then searched in electronic databases including PubMed, Medline, Google Scholar, and Scopus (1990-2026), for any analgesic research. This approach bridged historical ITM knowledge with contemporary scientific research. After rigorous screening and taxonomic verification of ITM literature, 13 out of 67 medicinal plants with otic analgesic properties cited in ITM were selected for review of their analgesic mechanisms. A search of scientific databases revealed that no study had specifically evaluated the otic analgesic effects of the selected plants; however, their analgesic, anti-inflammatory, and antipyretic effects were investigated in preclinical and clinical studies. Therefore, the proposed mechanisms by which these ITM plants alleviate otalgia are inferred from their antimicrobial, general analgesic and anti-inflammatory properties, primarily involving the activation of anti-inflammatory pathways and inhibitory effects on pain signaling within both the peripheral and central nervous systems. Further research is needed to specifically validate these otic analgesic mechanisms.