Secondary Otalgia: Referred Pain Pathways and Pathologies

Norris, Carrie D.; Koontz, Nicholas A.

doi:10.3174/ajnr.a6808

Cited by 16 publications

(14 citation statements)

References 38 publications

(58 reference statements)

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“…Convergence is believed to be a phenomenon in which a single second-order neuron receives nociceptive input from multiple sites, and the brain is unable to localize the correct primary stimulus [ 6 ]. It has been shown that migraine pain arises from the activation of meningeal perivascular afferents which are innervated by trigeminal nerve (CN V) [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…It has been shown that migraine pain arises from the activation of meningeal perivascular afferents which are innervated by trigeminal nerve (CN V) [ 7 , 8 ]. The trigeminal nerve also gives off numerous branches throughout the ear including those that provide sensation to the anterosuperior pinna, external auditory canal and the lateral tympanic membrane [ 6 ]. This viscerosomatic convergence of meningeal and extracranial cutaneous afferents can explain the extracranial symptoms of migraine such as allodynia in the territory of trigeminal nerve [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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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: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Migraine-Associated Otalgia: An Underappreciated Entity

et al. 2022

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“…[2][3][4][5] The earliest clinical or radiological signs of postoperative ICR (pICR) with occlusal disturbance or condylar resorption can occur 6 months after surgery; however, pICR is often observed instead at 1 or 2 years after surgery in most patients 4,[6][7][8][9][10][11][12] and ultimately leads to long-term relapse with decreased posterior facial height, progressive mandibular retrusion, and anterior open bite. [5][6][7][8][9][10][11][12][13][14][15][16][17] The pathophysiology of pICR is still not well understood. The main risk factors are suggested to be sex hormones and mechanical overloading on TMJ after orthodontic treatment, orthognathic surgery, trauma, internal derangement, occlusal therapy, or parafunctional habits.…”

Section: Discussionmentioning

confidence: 99%

“…Secondary otalgia arises from pathology outside the ear, such as trigeminal neuralgia, auriculotemporal neuralgia, major auricular neuralgia, median neuralgia, and geniculate ganglion pain. 14,15 An otologic examination should be performed first to confirm whether it is primary ear pain. Cranial nerve examination is considered if the primary disease has been excluded.…”

Section: Anatomy and Possible Mechanism Of Glossopharyngeal Neuralgia...mentioning

confidence: 99%

Glossopharyngeal Neuralgia Characterized by Otalgia: A Retrospective Study

Fan

Wang

Xia

et al. 2023

Journal of Craniofacial Surgery

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Glossopharyngeal neuralgia (GPN) is an uncommon facial pain syndrome and is characterized by paroxysms of excruciating pain in the distributions of the auricular and pharyngeal branches of cranial nerves IX and X. Glossopharyngeal neuralgia characterized by otalgia alone is rare. Herein, the authors analyzed 2 patients with GPN with otalgia as the main clinical manifestation. The clinical features and prognosis of this rare group of patients with GPN were discussed. They both presented with paroxysmal pain in the external auditory meatus and preoperative magnetic resonance imaging suggested the vertebral artery were closely related to the glossopharyngeal nerves. In both patients, compression of the glossopharyngeal nerve was confirmed during microvascular decompression, and the symptoms were relieved immediately after surgery. At 11 to 15 months follow-up, there was no recurrence of pain. A variety of reasons can cause otalgia. The possibility of GPN is a clinical concern in patients with otalgia as the main complaint. The authors think the involvement of the glossopharyngeal nerve fibers in the tympanic plexus via Jacobson nerve may provide an important anatomic basis for GPN with predominant otalgia. Surface anesthesia test of the pharynx and preoperative magnetic resonance imaging is helpful for diagnosis. Microvascular decompression is effective in the treatment of GPN with predominant otalgia.

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“…Earache, medically termed as otalgia, is the most common symptom among the patients presenting in ENT OPD. Usually the pathology is within ear, called otogenic, but it become mysterious when there is no pathological findings in the ear and the site is other than the ear, referred non-otogenic [1]. The otalgia due to nonotogenic cause is also known as "referred otalgia".…”

Section: Introductionmentioning

confidence: 99%

Frequency of Involvement of Different Head and Neck Sites in Referred Otalgia

Hussain¹,

Baig

Bhutta³

et al. 2021

JPRI

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Aim: To find out the most frequent head and neck sites of origin of referred otalgia. Study Design: Descriptive cross-sectional. Place and Duration of Study: Study was conducted at the ENT department of Bahawal Victoria hospital Bahawalpur during January 2019 to December 2019. Methodology: About 500 patients with ear ache were examined and after exclusion 150 were finally analyzed. Detailed history of the patient and clinical examination were done along with radio imaging and endoscopic studies wherever needed. Diagnosis of referred otalgia was made after having normal ear examination along with pathology lying at different head and neck region which share common sensory innervation. For analysis SPSS version-20 was used. Results: The mean age of the study participants was 28.23 ±13 years. The majority of participants were having otalgia of tonsillar origin followed by dental origin and pharyngitis with 31.3%, 23.3% and 16% respectively. Very few of them having otalgia originating from hypopharyngeal carcinoma and laryngeal carcinoma i.e. 3.3% and 2% respectively. While only 4.7% of otalgia were of unknown origin. Female participants were having higher frequency of otalgia which is originated from diseases of temporomandibular joint, hypopharyngeal carcinoma and otalgia of unknown origin in comparison to male participants but differences were insignificant. Otalgia originated from tonsillar and dental causes and due to pharyngitis were most common among the younger age group but having non-significant p-value. Conclusion: It has been concluded that the patients presenting with ear pain, have sometimes no underlying ear pathology. If the ear examination is normal then it is important to examine all other sites of head and neck which share sensory innervation with the ear including teeth, tonsils, pharynx, larynx, nose and paranasal sinuses to find out the exact cause of referred otalgia.

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Secondary Otalgia: Referred Pain Pathways and Pathologies

Cited by 16 publications

References 38 publications

Migraine-Associated Otalgia: An Underappreciated Entity

Migraine-Associated Otalgia: An Underappreciated Entity

Glossopharyngeal Neuralgia Characterized by Otalgia: A Retrospective Study

Frequency of Involvement of Different Head and Neck Sites in Referred Otalgia

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