Recurrent otalgia in adults

Finnikin, Samuel; Mitchell‐Innes, Alistair

doi:10.1136/bmj.i3917

Cited by 6 publications

(10 citation statements)

References 9 publications

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“…It is conceivable for an otolaryngologist presented with migrainous otalgia, to easily miss the diagnosis and attribute the symptoms to a primary ear or sinus condition [10]. Many studies documenting common causes for referred otalgia in the clinical setting do not examine migraine as a potential cause [18][19][20]. For example, in a study of origins of referred otalgia in a tertiary setting, 150 out of 450 patients had referred otalgia in which roughly 5% of patients (7 out of 150) had an unknown origin for their otalgia and none was attributed to migraines.…”

Section: Discussionmentioning

confidence: 99%

Migraine-Associated Otalgia: An Underappreciated Entity

et al. 2022

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Background and Objectives: Otalgia can be primary/otogenic or secondary as a referred pain from another site, which can be difficult to establish owing to various causes and the complex innervation of the ear. In our center, we observed a large group of patients with unexplained otalgia that had a higher prevalence of migraine. We hypothesized that migraine may cause secondary otalgia. This study then aimed to determine the prevalence of migraine-associated otalgia and evaluate the efficacy of migraine treatment. Subjects and Methods: This 2-year retrospective study was conducted at a busy otology clinic. Patients were identified using diagnostic codes corresponding to otalgia. The prevalence of migraine-associated otalgia was determined, and the efficacy of migraine treatment was evaluated in these patients. The interventions included prophylactic and abortive migraine treatments. Statistical analysis was conducted to compare between the pre-and post-treatment symptoms. Results: A total of 208 patients with otalgia were identified. Sixty-four out of ninety patients with unexplained otalgia met the criteria for migraine; of them, 30 patients had an adequate follow-up and were thus included in the evaluation of treatment efficacy. Otalgia improved in 87% of the patients who received migraine treatment. After treatment, the mean pain score and headache frequency significantly decreased from 7 to 2 and from 27 to 9 days per month, respectively (p<0.001). Conclusions: Migraine should be considered as a source of secondary otalgia, and patients should receive treatment as they often respond to migraine treatment.

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Section: Discussionmentioning

confidence: 99%

Migraine-Associated Otalgia: An Underappreciated Entity

et al. 2022

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“…22 Clinical reviews on the subject vary in their emphasis of imaging and at which point in the clinical pathway it should be considered. 19,[23][24][25][26] Some investigators have considered imaging to be appropriate after specialist review and in the presence of "red flag" clinical features (eg, weight loss and other UAT symptoms), particularly with prolonged and unilateral symptoms, 17,[23][24][25][26] though others state that it would be indicated in all patients who present with otalgia and a negative ear, nose, and throat examination. 19 This issue has become of increasing importance in the context of guidelines and targets for rapid imaging turnaround required for patients with suspected head and neck cancer.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Yield and Therapeutic Impact of Face and Neck Imaging in Patients Referred with Otalgia without Clinically Overt Disease

Ainsworth¹,

Pai

Kathirgamanathan³

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Otalgia may be secondary to serious pathology, such as upper aerodigestive tract malignancies, and CT or MR imaging of the skull base, face, and neck is often performed to detect clinically occult lesions. The diagnostic yield, management impact, and therapeutic impact of imaging in this clinical scenario, however, have yet to be elucidated. MATERIALS AND METHODS:CT and MR imaging in patients who presented with otalgia without clinically overt disease was retrospectively analyzed from a single center over a 9-year period. The cohort was subdivided into groups, depending on the presence of additional symptoms and a history of head and neck cancer. Relevant diagnostic outcome findings were categorized, and the diagnostic yield and impact of imaging on management and therapy were calculated for each group. RESULTS:In our study cohort of 235 patients, the diagnostic yield of imaging for otalgia, with or without other symptoms, in patients who lacked a history of head and neck cancer was negligible for upper aerodigestive tract malignancy (1%), abnormalities related to otalgia (2%), and other moderate or major findings (2%). Although equivocal or unimportant findings occasionally resulted in additional investigations, the therapeutic impact was also very low (2%). The diagnostic yield for upper aerodigestive tract malignancy (34%) and therapeutic impact increased (34%) when there was a history of head and neck cancer. CONCLUSIONS:The diagnostic yield and therapeutic impact of imaging for otalgia without clinically overt disease are very low, unless there is a history of head and neck cancer.ABBREVIATIONS: FNE ¼ fibreoptic nasendoscopy; UAT ¼ upper aerodigestive tract T he causes of otalgia (earache) are diverse and can be categorized as primary and secondary. Primary causes of otalgia are pathologies that affect the ear itself, 1 with common causes that include otitis externa, otitis media, 2 trauma, and foreign bodies. Primary otalgia often presents with overt clinical signs and can be managed without imaging studies. Secondary (referred) otalgia is caused by pathologies in locations outside the ear and results from shared pathways of sensory innervation. [1][2][3][4][5][6][7] Some etiologies may also be diagnosed on the basis of additional clinical findings and supported by targeted imaging (eg, temporomandibular joint or dental).Upper aerodigestive tract (UAT) malignancies are a potential cause of secondary otalgia, and it is a clinical feature that prompts rapid referral for head and neck cancer investigation in most clinical networks 8 ; therefore, fiberoptic nasoendoscopy (FNE) is usually performed in the early diagnostic work-up in these patients. Even in the presence of a normal FNE, clinicians may remain concerned that a submucosal UAT lesion or other clinically occult pathology may be present, so cross-sectional imaging is frequently proposed. Despite this common clinical practice, to our knowledge, the diagnostic value of face and neck imaging in patients referred with otalgia has no...

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“…A la inspección se puede observar edema, eritema y alteraciones cutáneas en el conducto auditivo externo, con una membrana timpánica sin alteraciones. Con un manejo adecuado estos pacientes deben mejorar en 72 horas con una recuperación completa de hasta 2 semanas, sin embargo, una otitis externa severa puede complicarse con pericondritis y celulitis del oído externo (5,6).…”

Section: Causas De Otalgia Primariaunclassified

“…En caso de ruptura de la membrana timpánica es común la presencia de descarga mucopurulenta no maloliente, que puede contener sangre. A la otoscopía, la observación de una membrana timpánica abombada, opaca y eritematosa es clave para el diagnóstico (2,4,5).…”

Section: Causas De Otalgia Primariaunclassified

Otalgia en el adulto: diagnóstico diferencial en atención primaria de salud

Simone¹

2021

Rev.méd.sinerg.

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La otalgia es un síntoma frecuente que puede ser causado por patología propia del oído (otalgia primaria) o por patología de otros sitios anatómicos que refieren el dolor al oído (otalgia secundaria). Al realizar el diagnóstico diferencial en atención primaria, resulta útil conocer que las causas más frecuentes de otalgia primaria son la otitis media y otitis externa, y en su defecto se deben considerar en primera instancia otras causas frecuentes como la disfunción de la trompa de Eustaquio o el barotrauma. Por otro lado, la otalgia secundaria, se debe con mayor frecuencia a causas odontológicas, faringitis o amigdalitis, trastornos de la articulación temporomandibular y neuralgias. Como etiologías de otalgia que ameritan referencia urgente se encuentra la arteritis temporal, complicaciones infecciosas e incluso infarto agudo al miocardio. También se deben considerar siempre factores de riesgo de cáncer, y consultar a un especialista en caso de sospecha o en caso de persistencia de los síntomas sin una etiología clara.

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Recurrent otalgia in adults

Cited by 6 publications

References 9 publications

Migraine-Associated Otalgia: An Underappreciated Entity

Migraine-Associated Otalgia: An Underappreciated Entity

Diagnostic Yield and Therapeutic Impact of Face and Neck Imaging in Patients Referred with Otalgia without Clinically Overt Disease

Otalgia en el adulto: diagnóstico diferencial en atención primaria de salud

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