The Radiology of Referred Otalgia

Abstract

SUMMARY:Pain referred to the ear is a well-documented phenomenon, which can be due to a multitude of disease processes. With the recent and rapid progression of CT and MR imaging technology, radiologists have played an increasing role in solving this potentially difficult diagnostic dilemma. Essentially any pathology residing within the sensory net of cranial nerves V, VII, IX, and X and the upper cervical nerves C2 and C3 can potentially cause referred otalgia. This article will attempt to outline the various sensorineural pathways that dually innervate the ear and other sites within the head and neck, as well as discuss various disease processes that are known to result in referred otalgia.

Computerised tomography in the investigation of otalgia of unknown origin: Our experience in 100 patients

“…Such examination should normally involve the ear, nose, throat, neck and upper aerodigestive tract, utilising flexible nasendoscopy. Failing identification of a possible cause for otalgia, it is accepted practice to then undertake further imaging of all potential pathologies affecting cranial nerves supplying sensation of the ear, normally in the form of a CT or MRI …”

“…This is often highlighted well by patients with tonsillitis, causing severe otalgia, with hypopharyngeal and laryngeal cancers often associated with mild to moderate otalgia. There are four cranial nerves and two upper cervical nerves that contribute to sensory innervation of the ear: cranial nerves V, VII, IX and X and upper cervical nerves C2 and C3 . Any imaging modality will need to encompass the distribution of these nerves, identifying pathology across their course.…”

ST-Elevation Myocardial Infarction Due to Left Anterior Descending Artery Occlusion Presenting Primarily with Otalgia

“…This mechanism can cause referred pain to the ear because the vagus nerve directly supplies the external auditory canal, which is known as the Arnold nerve [2,8]. Since our patient had an LAD and not an RCA occlusion, we theorize that referred pain to the vagus nerve can still occur because the sympathetic visceral afferent branches from the heart, which usually carry the pain signals, pass through the cardiac plexus, which the vagus nerve is part of [9].…”

A study on clinical profile of non otogenic otalgia

“…3 The ear is supplied by four cranial nerves (CN V, VII, IX, and X) and two superior cervical plexus nerves (C2 and C3). 4 These nerves also supply a lot of structures in head and neck. This rich innervation of the ear explains the central misinterpretation of the origin of pain arising from the head and neck and is the basis for referred otalgia.…”