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Otalgia is often related to pathology in areas of the head and neck apart from the ear. This is due to the rich innervation of the ear via the fifth, seventh, ninth and tenth cranial nerves and the cervical plexus. It is estimated that 50% of ear pain is referred from non-otologic sites. A case is reported where otalgia was due to the presence of a bone in place of a ligament in the neck and was relieved by its removal.
BACKGROUND: Patients with carcinomas of the upper aero-digestive tract often suffer from ear pain as a tumor associated syndrome. This prospective study examines the predictive and prognostic value of this symptom. PATIENTS AND METHODS: Ninety-six consecutive patients who completed a locally radiotherapy of a carcinoma of the oropharynx were prospectively evaluated and followed. Forty-nine out of 96 patients stated the symptom, either spontaneously or after questioning. The 2 groups showed no difference regarding TNM-classification, histology and total dose. Overall survival, local control and disease specific survival were calculated according to Kaplan-Meier and compared by the log-rank test. RESULTS: A clinically complete remission was obtained in significantly fewer patients with reflex-otalgia as compared to patients without reflex-otalgia, 61.2% versus 89.3%, p < 0.002. Local control of patients with reflex-otalgia was significantly less with 49%, mean follow-up 564 days, in comparison to local control in patients without reflex-otalgia, mean follow-up 613 days, p = 0.01. Disease specific survival was significantly worse for patients with reflex-otalgia, p < 0.012. The probability of local control of T1/T2 tumors with reflex-otalgia was similar to T3/T4 tumors without reflex-otalgia. Local control for all tumor categories combined is 74% for patients without reflex-otalgia versus 49% for patients with reflex-otalgia. CONCLUSION: In our patients, reflex-otalgia is a new and statistically significant parameter for the probability of local control and disease specific survival.
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BACKGROUND: First line antibiotic treatment of uncomplicated acute otitis media has been questioned. PATIENTS AND METHODS: In an prospective, open, controlled study, 390 children aged 1-10 years were treated either conventionally (free combinations of decongestant nose drops, mucolytics, analgesics and antibiotics) or alternatively with Otovowen, supplemented by conventional medications when considered necessary. RESULTS: Patients treated conventionally took more antibiotics (80.5% vs 14.4%) and analgesics (66.8% vs 53.2%). The time to recovery (5.3 vs 5.1 days) and absence from school or pre-school nursery (both 1.7 days) were not significantly different between groups. Pain resolution was slightly better with conventional treatment (-5.8 vs -5.2 score points). The alternative treatment was judged both by doctors, and parents, to be significantly better tolerated. CONCLUSION: In uncomplicated acute otitis media of childhood, an alternative treatment strategy with the natural medicine Otovowen may substantially reduce the use of antibiotics without disadvantage to the clinical outcome.
Speculations concerning a possible association between temporomandibular disorders (TMDs) and ear symptoms of otalgia and tinnitus have been made in the dental and medical literature for a long time. Current understanding of this association is reviewed. An analysis of relevant studies published between 1947 and 1996 shows that a relatively high percentage of TMD patients reported the presence of ear pain and noise. However, a cause-effect relationship has not been established to date. Theories that try to explain the concurrence of TMD symptoms and ear symptoms (particularly tinnitus) by a common underlying cause remain speculative. It has to be taken into consideration that due to their high prevalence, TMDs and ear symptoms in a given patients may be present by chance alone. A methodological weakness of most of the studies available is the fact that control groups were not considered. Owing to the lack of prospective, controlled, and randomized studies, statements regarding the effectiveness of certain dental measures for the treatment of otalgia and tinnitus in TMD patients are not well supported.
AIMS OF THE STUDY: The high prevalence of ear, nose, and throat symptoms in patients with craniomandibular disorders seems to depend on the connection between both phenomena. The present study evaluates the connection between craniomandibular disorders (CMD) and otalgia or tinnitus, investigates the correlation between specific diagnoses of CMD with otalgia or tinnitus, and estimates the effects of treatment of CMD on these ear symptoms. PATIENTS AND METHODS: The information from case histories, clinical examinations, and treatment results of 221 patients with CMD were coded and evaluated by computer. All patients received conservative treatment with occlusal splints, training in self-observation of parafunction, massage of the masticatory muscles, and heat therapy. At least 1 year after the first examination, all patients were reevaluated. According to their complaints, the patients could be divided into three groups: (1) CMD patients without ear symptoms (n = 134 = 61%), (2) CMD patients with otalgia (n = 80 = 37%), and (3) CMD patients with tinnitus (n = 8 = 3.8%) (one patient with tinnitus and otalgia). RESULTS: Otalgia correlated significantly with CMD and the specific CMD diagnoses of anterior disk displacement (ADD) without reduction and osteoarthrosis. Of the reevaluated patients with otalgia, 90% had no ear pain and 10% reported reduced or less frequent ear pain. Only one of the eight cases with tinnitus noted reduced noises; the remaining seven perceived no influence on their ear noises from therapy. CONCLUSIONS: Due to the treatment results, otalgia has to be interpreted as a possible symptom of CMD and not as a separate diagnosis.
Reflex otalgia is a predictive and prognostic parameter for local control in patients with oropharynx carcinoma. Can a morphologic correlate of this important symptom be detected by MRI? Thirty-six patients were prospectively evaluated by MRI before radical radiotherapy. Sixteen patients had reflex otalgia; 20 did not. The oropharynx and adjacent regions were analyzed. Alteration was defined as effacement of anatomical structures, signal alteration or enhancement after contrast medium administration. The chi(2)-test was used to compare categorical parameters. In patients with reflex otalgia, alteration of the following structures innervated by the glossopharyngeal nerve were found significantly more often: nasopharynx, hard palate, superior constrictor pharyngis muscle, palatine tonsil, palatopharyngeus muscle, palatoglossus muscle, stylopharyngeus muscle, hyoglossus muscle and preepiglottic space. No difference was found for the muscles of mastication, levator and tensor veli palatini muscles, styloglossus muscle, genioglossus muscle, intrinsic muscles of the tongue, digastric muscles, mucosal surface of the lateral and posterior pharyngeal wall, uvula, valleculae, parapharyngeal space and larynx. An alteration of structures innervated by the glossopharyngeal nerve was visualized on MRI significantly more often when reflex otalgia was present. Involvement of structures innervated by other cranial nerves did not show the same association with ear pain.
The purpose of this study was to investigate if there is any relationship between the age of a patient and the degree of facial nerve recovery in patients with Bell's palsy. Between 1987 and 1995 250 patients with peripheral idiopathic facial nerve palsy were examined at the ENT Clinic of the University of Ioannina. In this group 134 were male and 116 were female. The patients' ages ranged from 4 to 80 years and had an average of 47.7 years. The average age of the male patients was 46.5 years and that of the female patients was 49.1 years. In the overall group of 250 patients 129 presented with a paralysis of the right facial nerve and 121 on the left. There was no case of bilateral palsies. When comparing the age of the patients and the degree of recovery, measuring age was associated with a decrease in complete recovery. While the percentage of complete recovery between age 4 and 50 years varied from 83% to 74%, respectively, the percentage of complete recovery decreased to less than 54% at age 80. Our results show that the age of the patient is a very important factor for facial nerve recovery.
The aim of the study was to determine the frequency of clinical allodynia, osmophobia and red ear syndrome in a young population. Medical records of the children admitted for headache between 1 December 2004 and 31 March 2005 were consecutively studied. A questionnaire was used to find the prevalence of allodynia, osmophobia and red ear syndrome. We visited 96 children with headache. The range of age was 6-18 years. We classified migraine in 57%, other primary headaches in 25% and secondary headaches in about 18%. The presence of ipsilateral clinical allodynia was 14.5% in migraine, osmophobia in 20% of migraine and red ear syndrome in about 24% of migraine cases and they were absent in the other two headache groups. Our study shows that features like osmophobia, allodynia and red ear syndrome are not uncommon in migraine while they are absent in other types of headache.
Otitis media continues to present a major challenge to practitioners in the clinical setting. With the ever-increasing trend toward the use of a sound research-structured approach to health care and the use of evidence-based guidelines, it is important to have an understanding of these findings related to otitis media. A review of research-supported literature regarding the diagnosis and management of this disease, and suggestions for the judicious use of antibiotics, are presented in this paper.
It has been long recognized in the otolaryngic community that despite great effort dedicated to the physiology and pathology of the ear, nose, throat/head and neck, there are a number of symptoms, including pain in various locations about the head and neck, which cannot be explained by traditional otolaryngic principles. The tenets of myofascial dysfunction, however, as elucidated by Dr. Janet Travell, explain most of these previously unexplained symptoms; furthermore, treatment based on Dr. Travell's teachings is effective in relieving these symptoms.
A heterogeneous group of 105 TM patients were questioned about tinnitus and otalgia at an initial visit and again at a final visit 32 months later. Analysis of data showed no statistically positive correlation between the two symptoms although most patients had difficulty in separating onset of both symptoms. Tinnitus was more common within 1 to 5 years after onset than 10 to 15 years after onset. Tinnitus appeared to be an individual problem and was neither group- nor gender-related. Few patients identified an etiology for tinnitus. The use of oral appliances seemed to reduce or eliminate symptoms and the number of patients with fluctuating tinnitus decreased by one half between visits. No change occurred for patients with severe tinnitus.
To investigate if there is a relationship between gastroesophageal reflux and ear pain in the pediatric age group, a series of children presenting with this picture were analyzed. Infants and children are often seen in an emergency room setting because of fretfulness, irritability, and pulling on the ears. A diagnosis of otitis media is usually made, but in some cases the diagnosis may be referred otalgia secondary to gastroesophageal reflux. Six children who presented with the above picture were seen by one of the authors (W.S.G.) the following morning and noted to have a normal ear exam. These children were studied for gastroesophageal reflux by esophageal pH monitoring and in some cases esophagoscopy with biopsy. All children exhibited gastroesophageal reflux and an anti-reflux regimen eliminated the pattern of 'recurring otitis media'. This paper will review the mechanism of referred otalgia along with data supporting the concept of GE reflux as a cause of otalgia in infants and children.
Referred otalgia is a challenging symptom, with the burden on the physician to identify the source. Only by careful patient history and physical examination can all causes in this extensive differential diagnosis be excluded. In the absence of primary otologic pathology, referred pain from a head and neck carcinoma must be considered foremost and ruled out.
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Middle ear (ME) carcinoid tumor is exceedingly rare. We present a case of ME carcinoid tumor in a 29-year-old woman whose chief complaints were right otalgia, aural fullness, hearing loss, and facial palsy of 5 days duration. A reddish bulging mass behind the right eardrum and right facial palsy staged as grade IV on the House-Brackmann scale were noted. The high-resolution computed tomography of the temporal bone showed a soft-tissue density mass in the right middle ear and antrum without bony invasion. Although the initial diagnosis was ME adenoma made by the intraoperative frozen section report, the tumor was resected completely by a modified conservative ossicles-preservation method. The patient's initial symptoms of otalgia, aural fullness, and hearing loss immediately improved after surgery, and facial palsy diminished in the following months. No recurrence was noted after 12 months of follow-up.
We report a case of capillary hemangioma of the tympanic membrane in a 51-year-old man with conductive hearing loss, otalgia, and otorrhea. On examination, the external auditory canal was obstructed with a hard, dark red tumor, and purulent discharge was observed. The infection was controlled with antibiotics, but hearing loss persisted. Therefore, transcanal resection was performed. The tumor was attached to the postero-superior quadrant, and arose from the lamina propria. Histologically, the tumor was composed of multiple capillary-sized vessels surrounded by fibrous connective tissue and diagnosed as capillary hemangioma. After surgical treatment, hearing loss was diminished, and there has not been any sign of recurrence for 3 years despite the positive surgical margin.